G2211: Are you leaving reimbursement on the table?

Editor’s note: Are changes coming to the G2211 code for 2027? Under the proposed 2027 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) would change how it pays for code G2211, the add-on code that accounts for the complexity of ongoing office and outpatient evaluation and management (E/M) visits. Rather than billing G2211 as a separate, flat-rate add-on, CMS proposes converting it into a two-digit modifier attached directly to the base E/M code. That modifier would increase payment by 16% of the base E/M rate rather than a fixed dollar amount, applying the same percentage increase across all E/M visit levels. Both the American Academy of Neurology and the American College of Physicians reacted favorably to the change. ACP said the shift could better reflect real differences in physician work across visit levels, better compensate complex, longitudinal care and simplify billing by removing a separate claim line. ACP also noted CMS is proposing an enhanced 32% version of the adjustment for physicians participating in Medicare Shared Savings Program accountable care organizations and the Long-Term Enhanced ACO Design (LEAD) model.