LUGPA Fact Sheet: HCPCS Code G2211Nov. 13, 2023 Introduction: CMS is set to implement a significant coding change effective January 1, 2024. This change involves the introduction of a separate add-on payment for the Healthcare Common Procedure Coding System (HCPCS) code, G2211. This add-on code aims to better recognize the resource costs associated with evaluation and management (E/M) visits for specific types of medical care. G2211 is generally limited to the Medicare program. This fact sheet provides an overview of HCPCS code G2211 and its implications, but you should, as always, consult with your institution’s billing department and specific practice guidelines in assessing individual circumstances or practice applicability. HCPCS Code G2211: HCPCS code G2211, known as the 'cognitive code,' is intended to account for the work involved when clinicians are the continuing focal point for all needed healthcare services or are part of ongoing care related to a patient's single, serious, or complex condition. It is an add-on code to office and other outpatient E/M visits (99202–99215 with a wRVU of .33) Who Will Use HCPCS Code G2211? CMS expects that this code will be used by primary care providers and those from certain other specialties, including urology, who treat a single, serious, or complex condition over a longitudinal period. Limitations on Usage: For the year 2024, CMS has stated that HCPCS code G2211 may not be reported when modifier 25 is used with the E/M service on the same day. Modifier 25 is a Medicare modifier that is used to indicate a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional (QHP) on the same day of the procedure or other service. Specific Criteria for Using HCPCS Code G2211: CMS has clarified that not all visits in urology will meet the criteria for eligibility under HCPCS code G2211. For instance, patients seeking care for acute urological issues that do not necessitate additional efforts for coordination or follow-up may not meet the qualifications. Examples of conditions that may not warrant this code include a vasectomy consult, which is typically straightforward and implies a finite clinical relationship, as the code is not applicable if the condition does not require attention to an ongoing medical need over some interval of time. Expected Frequency of Use: CMS anticipates that HCPCS code G2211 will initially be billed with 38 percent of all E/M services and that this will increase to 54 percent of all E/M services when fully adopted. It's important to note that not all physicians or non-physician practitioners will use the code with the same frequency. Summary: HCPCS code G2211 represents a significant change in the coding and billing landscape, emphasizing CMS’s focus on the importance of continuity and consistency in patient care. While it offers the potential for improved recognition of resource costs for certain E/M services, its implementation comes with specific criteria and potential budget neutrality implications that need to be considered. Please refer to the official CMS documentation and consult with relevant healthcare authorities for additional information and guidance. Additional Links Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule AAPC Information on G2211 CMS Code Sets Overview |
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