HCPCS G2213: ED OUD treatmentMedicare rate & RVUs in Illinois
Use this add-on when emergency department care includes starting medication for opioid use disorder, assessing the patient, and arranging ongoing treatment.
Medicare pays $67.42–$72.92 for G2213 in the office in Illinois, from Rest Of Illinois to Chicago. 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 G2213 covers
G2213 captures emergency department work to begin medication treatment for opioid use disorder and connect the patient with continuing care. The service includes assessment, referral to ongoing treatment, and arranging follow-up. It may be relevant when a patient presents with opioid withdrawal or another emergency concern and the ED team initiates treatment rather than limiting care to evaluation and referral. Emergency physicians and other qualified clinicians may provide this work in the ED.
Report G2213 with the primary emergency department service, not by itself. Choose the ED evaluation and management level based on the documented visit; record the opioid use disorder assessment, medication initiation, referral plan, and follow-up arrangements supporting the add-on. CMS identifies G2213 as an add-on code paid within the primary procedure’s global period, so it is reported in connection with that primary 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.
Where G2213 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$67.42 to $72.92
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $72.92 | $60.83 |
| East St. Louis | $69.66 | $58.60 |
| Rest Of Illinois | $67.42 | $56.44 |
| Suburban Chicago | $70.90 | $58.55 |
How the G2213 rate is calculated
Each of G2213’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 · G2213
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.27Practice expense 0.58Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G2213
The CMS indicators that decide how G2213 is paid alongside other services.
CMS payment indicators · G2213
ED OUD treatment
| 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. |
G2213 compared with similar codes
Compare codes
G2213 vs G2214 vs G2215 vs G2216: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G2214Psychiatric collaborative care
- G2214 describes psychiatric care management work; G2213 is for initiating medication treatment for opioid use disorder in the emergency department and arranging ongoing care.
- G2215Home supply nasal naloxone
- G2215 covers a home supply of nasal naloxone. G2213 covers ED medication initiation for opioid use disorder and linkage to continuing treatment.
- G2216Home supply inject naloxon
- G2216 covers a home supply of injectable naloxone. G2213 describes ED opioid use disorder medication initiation, assessment, referral, and follow-up arrangements.
G2213 billing questions
Does G2213 replace the emergency department E/M code?
No. G2213 is an add-on for medication initiation and linkage to ongoing opioid use disorder care; report it with the applicable ED E/M service.
What documentation supports G2213?
Document the opioid use disorder assessment, the medication treatment initiated, and the referral and follow-up arrangements made for continuing care.
Can G2213 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure.
Is G2213 a code for dispensing naloxone at discharge?
No. G2213 describes ED medication initiation for opioid use disorder and care linkage. G2215 and G2216 describe home supplies of naloxone.
How is the primary ED E/M level selected?
Select the ED E/M level based on the documented evaluation and management for the encounter. G2213 captures the additional medication-initiation and follow-up work.
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
Show the CMS file lines behind this rate
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