HCPCS G2211: Visit Complexity Add-On for Longitudinal E/M Care
HCPCS G2211 is an add-on for the inherent visit complexity of an office/outpatient E/M when the provider is the continuing focal point for a patient's care or manages a single serious or complex condition. In 2026 Medicare pays about $17.37 non-facility (0.52 total RVUs times the $33.4009 conversion factor) and about $14.36 in a facility.
- Code type
- E/M visit-complexity add-on
- 2026 non-facility
- $17.37 (0.52 RVUs)
- 2026 facility
- $14.36 (0.43 RVUs)
- Reported with
- Office/outpatient E/M (99202-99215)
What is HCPCS G2211 used for?
G2211 is a Medicare visit-complexity add-on that recognizes the extra, ongoing work of longitudinal care. You append it to an office or outpatient E/M (99202-99215) when you are the patient's continuing focal point for care or are managing a single serious or complex condition. It pays for the relationship, not a discrete procedure, and it applies broadly, most primary-care and many specialty follow-up visits qualify.
The key qualifier is the relationship, not the acuity of a single visit. A one-off encounter with no ongoing relationship does not support G2211, but a routine follow-up for a patient whose care you continuously coordinate does, even at a lower E/M level. Because it rides on the base E/M, the base code must be valid and payable on its own before you attach the add-on.
How much does G2211 pay in 2026?
G2211 carries 0.52 non-facility RVUs and 0.43 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $17.37 non-facility and $14.36 in a facility. Example: a 99214 plus G2211 pays roughly $135.61 + $17.37 = $152.98 non-facility; the same add-on on a 99213 lifts it from about $95.19 to about $112.56. It is small per claim, but across a full panel billed consistently on qualifying visits it compounds into meaningful annual revenue. Model it on the Medicare fee calculator.
How does G2211 interact with modifier 25?
This is the rule that changed and still trips billers up:
| Period | G2211 with a modifier-25 E/M? |
|---|---|
| 2024 | Not allowed when modifier 25 was on the E/M |
| 2025 onward | Allowed when the same-day service is an AWV, vaccine admin, or certain Part B preventive services |
Frequently asked questions
Bill G2211 with an office or outpatient E/M (99202-99215) when you are the continuing focal point for all of the patient's health care needs, or when you are managing a single serious or complex condition. It reflects the added value of longitudinal, relationship-based care. It is not for one-off visits with no ongoing relationship.
The 2026 national non-facility allowed amount is about $17.37 (0.52 total RVUs times $33.4009) and about $14.36 in a facility. It is small per claim, but at primary-care volume it adds meaningful annual revenue when billed consistently on qualifying visits.
It depends on why modifier 25 is used. Originally CMS barred G2211 whenever modifier 25 was on the E/M. Effective January 1, 2025, CMS allows G2211 with a modifier-25 E/M when the same-day service triggering the modifier is an annual wellness visit, vaccine administration, or certain other Part B preventive services. Verify the specific pairing before billing.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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