HCPCS code G2212: Prolonged office visit, medicare add-on, each 15 minutes2026 Medicare rate & RVUs in Missouri
Report G2212 for each qualifying 15-minute increment of practitioner time beyond a time-based level 5 office or outpatient visit under Medicare.
Medicare pays $32.37–$33.50 for G2212 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What G2212 covers
G2212 captures prolonged physician or qualified health care professional work for a new or established level 5 office or outpatient E/M visit selected by total time. Time on the service date may include reviewing outside records, examining and counseling the patient, discussing treatment with other clinicians, and documenting the encounter, whether or not the patient is present. Physicians, nurse practitioners, and physician assistants may report it in primary care or specialty clinics and hospital outpatient departments when extensive record review and extended counseling make a visit unusually long.
Report G2212 with 99205 or 99215; Medicare uses it instead of CPT 99417 for these prolonged visits. Current CPT sets a minimum of 60 minutes for 99205 and 40 minutes for 99215. Under Medicare's prolonged-time thresholds, the first G2212 unit begins at 89 total minutes with 99205 or 69 with 99215; another unit begins after each further 15 minutes. Document total practitioner time on the date and the work performed. Exclude clinical staff time and time spent on separately reported services.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G2212 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$32.37 to $33.50
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $33.30 | $27.02 |
| Metropolitan St. Louis, MO | $33.50 | $27.14 |
| Rest of Missouri | $32.37 | $26.61 |
How the G2212 rate is calculated
Each of G2212’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G2212
RVUs × geographic indexes × conversion factor
Work0.61
0.61 RVUs× 1.000 GPCI
Practice expense0.36
0.36 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.0200
Conversion factor
$33.4009
Medicare rate
$34.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G2212
G2212 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · G2212
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$34.07
- Non-facility (office)
- $34.07
- Facility
- $27.39
Higher because the practice carries its own overhead.
G2212 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99417Prolonged E/MOffice or outpatient
- Both describe prolonged time with a time-based 99205 or 99215, but they use different reporting thresholds. Medicare uses G2212 for these visits; some non-Medicare payers use CPT 99417.
- G2211Visit complexity add-onOngoing longitudinal patient relationship
- G2211 reflects visit complexity tied to an ongoing care relationship or care for a serious condition. G2212 requires prolonged practitioner time beyond a time-based level 5 visit.
- G0316Prolonged E/MInpatient or observation care
- G0316 addresses prolonged hospital inpatient or observation E/M care. G2212 is reported with a qualifying office or outpatient visit coded 99205 or 99215.
G2212 billing questions
When does the first unit become reportable?
For Medicare, the first unit begins at 89 minutes of total practitioner time with 99205 or 69 minutes with 99215. A second unit begins at 104 or 84 minutes, respectively.
Can G2212 be used when the level 5 visit was chosen by medical decision making?
No. The 99205 or 99215 visit must be selected using total time to support G2212.
Should 99417 or G2212 be billed to Medicare?
Use G2212 for Medicare prolonged time with 99205 or 99215. CPT 99417 uses a different threshold and may be used by non-Medicare payers.
Can G2212 be reported with a lower-level visit such as 99214?
No. G2212 pairs with a time-based 99205 or 99215. Select the office or outpatient visit level supported by total practitioner time before assessing prolonged time.
Can G2212 and G2211 accompany the same visit?
Yes, when the time-based level 5 visit meets the requirements for both prolonged time and the visit complexity add-on.
What time is excluded from the G2212 calculation?
Exclude clinical staff time, travel time, and time spent on separately reported services, such as a procedure or test interpretation. Count qualifying physician or qualified health care professional time on the visit date.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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