G2211: Medicare Billing Guidelines, RVUs and Modifier 25

G2211 is a Medicare HCPCS add-on code that pays extra on an office/outpatient or home E/M visit when the practitioner is the patient's continuing focal point for care or is managing a single serious or complex condition over time. You bill it as one unit on the same claim as the E/M code; it's denied when that E/M carries modifier 25 for a same-day procedure, but paid when modifier 25 is there for an annual wellness visit, a vaccine administration or another Part B preventive service.

What G2211 means

CMS's descriptor for G2211, as refined in the CY 2026 PFS final rule, reads: "Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (Add-on code, list separately in addition to home or residence or office/outpatient evaluation and management service, new or established)" (CMS G2211 FAQ).

In practice that's two kinds of relationship:

• Continuing focal point. You're the practitioner the patient comes back to for whatever they need, the classic primary care relationship. CMS's own example is a primary care patient seen for sinus congestion: the problem is simple, but the visit draws on and builds a long-term relationship, so G2211 applies (MLN Matters MM13473).
• Ongoing care for a single serious or complex condition. A specialist who manages one condition over time, such as an infectious disease physician treating a patient with HIV or a practitioner caring for a patient with sickle cell disease (G2211 FAQ, Q8).

CMS doesn't define "longitudinal" with a visit count or interval, and no specific diagnosis is required (FAQ, Q8 and Q9). What disqualifies a visit is a relationship that is "discrete, routine, or time-limited": CMS lists a mole removal or a referral for one, treating a simple virus, counseling for seasonal allergies, initial-onset reflux, and treating a fracture, where comorbidities aren't present or addressed and you haven't taken (and don't plan to take) responsibility for the patient's ongoing care (FAQ, Q1).

Sources: CMS, Frequently Asked Questions About E/M Visit Complexity Add-On HCPCS Code G2211 (cms.gov/files/document/hcpcs-g2211-faq.pdf, CY 2026 edition); MLN Matters MM13473 (revised April 29, 2025). Verified October 6, 2026.

G2211 billing guidelines

These are the rules Medicare applies, each from the CMS FAQ or MLN Matters MM13473:

1. Bill it with a qualifying base code. Office/outpatient E/M visits 99202–99205 and 99211–99215, at any level, new or established. From January 1, 2026, also home or residence visits 99341, 99342, 99344, 99345 and 99347–99350. Never on its own.
2. Not with other E/M families. Hospital inpatient, emergency department and nursing facility E/M codes aren't base codes for G2211.
3. Any specialty, any setting. CMS doesn't restrict G2211 by specialty, and it's separately payable in both facility and non-facility settings.
4. One unit per visit. G2211 describes the inherent complexity of that visit, so it's reported once with the E/M line.
5. Document the visit. CMS hasn't set extra documentation requirements. Reviewers may use the record (diagnoses, your assessment and plan, other codes billed, claims history) to confirm the relationship.
6. Collect cost sharing. The usual Part B coinsurance and deductible apply to G2211.

A patient seen by a colleague in your group can still qualify. If the practice delivers team-based care and serves as the continuing focal point, CMS says G2211 "may be appropriate" when another physician or practitioner on the team sees the patient (FAQ, Q3). It can also be billed for teaching-physician services under the primary care exception (modifier GE), and in the same month as care management services such as CCM, which CMS doesn't consider duplicative (FAQ, Q4 and Q11).

Is G2211 eligible? Walk through it

When G2211 can't be billed: the modifier 25 rule

Since G2211 became payable on January 1, 2024, Medicare has denied it when the office/outpatient E/M it's attached to is reported with modifier 25 on the same date, for the same patient, by the same practitioner (CY 2024 PFS final rule, 88 FR 78974–78975; MLN Matters MM13272). The logic: modifier 25 means a procedure or other service shared the day, and CMS doesn't add the complexity payment to those visits.

The CY 2025 PFS final rule carved out an exception. From January 1, 2025, G2211 is payable even when the E/M carries modifier 25, as long as the other same-day service is:

• an annual wellness visit (G0438 or G0439),
• a vaccine administration, or
• any Medicare Part B preventive service furnished in the office or outpatient setting (89 FR 97858; CR 13705, attachment 1 lists the services).

The CY 2026 final rule extended the same exception to home or residence E/M base codes from January 1, 2026 (FAQ, Q6).

For how modifier 25 itself works, see modifier 25 vs 59.

Can G2211 be billed with G0439?

Yes, but not as an add-on to G0439 itself. G2211 always rides on the E/M code. When a patient's AWV (G0439, or G0438 for the first one) and a problem-oriented office visit happen on the same day, the claim carries G0439, the E/M with modifier 25, and G2211. Since 2025 that combination pays. Our annual wellness visit guide covers the AWV side of that claim.

G2211 RVU and payment

G2211 has its own relative value units on the fee schedule, with a global period of ZZZ (an add-on that's always billed with another service). Its practice expense RVU is lower in a facility than in an office, so the add-on, like the visit, pays more in the office.

The add-on is a flat amount: it's the same whether the base visit is a 99212 or a 99215. That makes it a larger share of a low-level visit. Compare it with the two most-billed established-patient visits:

For how RVUs, GPCIs and the conversion factor combine into the allowed amount, see what an RVU is or run any code at your ZIP in the RVU calculator.

Is G2211 only for Medicare?

G2211 is a HCPCS Level II code that CMS created for the Medicare Physician Fee Schedule. Every rule on this page is Medicare's. Medicare Advantage plans, Medicaid programs and commercial payers decide for themselves whether to recognize and pay it, and some follow Medicare's policy while others don't. Check each payer's policy or fee schedule before adding it to non-Medicare claims.

Telehealth, place of service and G2211

G2211 is on CMS's CY 2026 list of Medicare telehealth services, as are the office/outpatient E/M codes it's billed with. When the visit is furnished by telehealth and Medicare pays it, bill G2211 the same way you'd bill it in person, with the place of service and modifiers that apply to the visit. See place of service codes for POS 02 vs 10 and modifier 95.

What CMS proposed for 2027

In the CY 2027 PFS proposed rule (fact sheet, July 14, 2026), CMS proposed replacing G2211 with a modifier on the E/M base code that would raise the visit's payment by 16%, so the add-on scales with the visit level instead of being a flat amount. It also proposed a second modifier, worth 32%, for practitioners in Shared Savings Program ACOs or LEAD Model ACOs. These are proposals; until CMS finalizes a change, G2211 is billed as described above.

Sources: CY 2024 PFS final rule, 88 FR 78818, 78970–78982; CY 2025 PFS final rule, 89 FR 97710, 97856–97858; CY 2026 PFS final rule, 90 FR 49266, 49462–49464; MLN Matters MM13272 and MM13473; CMS CY 2026 Medicare Telehealth Services List; CMS fact sheet, CY 2027 PFS proposed rule (July 14, 2026). Verified October 6, 2026.