HCPCS G2211: Visit complexity add-onMedicare rate & RVUs in Delaware
Medicare add-on for office or outpatient E/M when the practitioner is the patient's continuing care focal point or manages a serious or complex condition over time.
Medicare pays $17.29 for G2211 in the office in Delaware (Delaware). 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.
On this page 9 sections
What G2211 covers
G2211 recognizes the extra cognitive work of being responsible for a patient over time, not the difficulty of a single encounter. It applies when the billing practitioner is the continuing focal point for all of the patient's needed services, as primary care physicians, nurse practitioners, and physician assistants typically are, or provides ongoing care for a single serious or complex condition. Examples include an endocrinologist managing a patient's diabetes or an infectious disease physician following a patient with HIV. It is reported for office and outpatient visits, including those furnished by telehealth.
Report one unit with a new or established patient office or outpatient E/M code (99202-99215). Documentation should support the longitudinal relationship, such as an ongoing care plan, chronic condition management, or the practitioner's role in coordinating the patient's care. The relationship can begin with a new patient visit when ongoing care is expected. It does not fit a one-time or time-limited episode. As an add-on, G2211 is billed only with its primary E/M and paid within that service's global period. It is generally not payable when the base E/M carries modifier 25, except when that visit is reported on the same day as an annual wellness visit, vaccine administration, or a Medicare Part B preventive service.
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.
G2211 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $17.29 | $14.32 |
How the G2211 rate is calculated
Each of G2211’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 · G2211
RVUs × geographic indexes × conversion factor
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Work 0.33Practice expense 0.17Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G2211
The CMS indicators that decide how G2211 is paid alongside other services.
CMS payment indicators · G2211
Visit complexity add-on
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
G2211 compared with similar codes
Compare codes
G2211 vs G2212 vs 99490 vs 99214: national Medicare rates
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How to choose
- G2212Prolonged office visit
- G2212 is time-based and adds payment for extended time beyond a 99205 or 99215 threshold; G2211 is not time-based and reflects the ongoing practitioner-patient relationship.
- 99490Chronic care management
- 99490 pays for monthly non-face-to-face chronic care management staff time; G2211 is attached to an in-person or telehealth office visit and recognizes longitudinal work inherent in that visit.
- 99214Office visit
- 99214 is the visit itself, leveled by medical decision making or time; G2211 never stands alone and is appended only when longitudinal care criteria are documented.
G2211 billing questions
Does G2211 require the visit itself to be of high complexity?
No. The add-on reflects the ongoing relationship and the practitioner's responsibility for the patient's care over time, so it can accompany a straightforward or low-complexity visit if the longitudinal criteria are met.
Which primary codes can G2211 be reported with?
It is reported with office and outpatient E/M codes 99202-99215, for both new and established patients. It cannot be billed on its own.
Can G2211 be billed when the E/M has modifier 25?
Generally no. CMS allows it with a modifier 25 E/M when that visit occurs on the same day as an annual wellness visit, vaccine administration, or a Medicare Part B preventive service, but not when the separate service is a minor procedure.
Can specialists report G2211?
Yes, when the specialist provides ongoing care for a single serious or complex condition, such as a rheumatologist managing rheumatoid arthritis. A one-time consultative visit or a short episode of care does not qualify.
Can G2211 and G2212 be reported on the same claim?
Yes. When a 99205 or 99215 visit meets the time threshold for Medicare prolonged services and the longitudinal criteria are met, both add-ons may be reported with the same base visit.
Does patient cost-sharing apply to G2211?
Yes. Medicare deductible and coinsurance apply to G2211 as they do to the base office visit.
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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