Beginning in January, physicians will be able to receive more accurate payment for complex visits with Medicare add-on code G2211. But the Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Initially proposed in 2021 by the Centers for Medicare & Medicaid Services (CMS), the code’s 2024 implementation includes several changes advocated for by the Texas Medical Association including:
- More clarification by CMS on when physicians can use the code;
- Assurances that physicians will be paid appropriately for time spent caring for patients regardless of delivery type; and
- Office visit increases applied uniformly across all services and specialties without holding specific specialties to a different standard from others.
CMS’ 2024 Medicare Physician Fee Schedule Final Rule issued Nov. 2 heeded TMA’s concerns about decreasing the code’s impact on payment for other services by including a lower utilization estimate and guidelines for when it may be billed, including prohibiting its use with modifier 25.
“A primary care clinician, as the continuing focal point for all needed health care services for a patient, often bears the cognitive load, responsibility, and an accountability for building the most effective, trusting relationship possible amidst evaluating and managing other health care problems during a visit,” CMS said in the fee schedule. “This add-on code will better recognize the resource costs associated with evaluation and management visits for primary care and longitudinal care.”
However, Houston internist and chair of TMA’s Council on Socioeconomics, Gary Sheppard, MD, worries that without modifier 25 – used when physicians perform a procedure and provide another service on the same day as an office or outpatient evaluation – patients will be forced to wait for necessary care while physicians try to fit multiple appointments into their already busy schedule.
“The modifier allows us to do two things [in] one visit and still get paid for the work we do. It’s easier for both the patient and the doctor,” he said. “Without the modifier, a patient will need to come in for a separate visit for one service, like a physical, that may not address their chronic problems, and then schedule another visit to address more specific concerns. This doesn't make sense. Why should they have to come in twice?”
Dr. Sheppard also says clearer communication from CMS on how to properly use the code is still needed and he worries that until then, physicians will avoid using G2211 to avoid possible denials.
However, he remains hopeful that the code will recompense physicians for extra work required for the coordination of care for patients with complex or serious conditions.
"The idea behind the code is to help physicians receive payment for extra time and manpower that you expend when you see more complicated patients, and that’s a good thing. I’m still hopeful that G2211 will provide a better pathway for physicians to receive payment, and we’ll continue to work to see to that end.”
TMA will continue to push for increased guidance from CMS. For now, the agency has a few examples of services which the code G2211 should be reported.
For more information on billing and coding, visit TMA’s comprehensive Billing, Coding, and Reimbursement page.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469