G2211 Visit complexity add-on Medicare reimbursement rates in Virginia

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.