HCPCS G2212: Prolonged Outpatient E/M for Medicare, Each 15 Minutes
HCPCS G2212 is Medicare's prolonged services add-on for each additional 15 minutes of office or outpatient E/M beyond a level-5 visit (99205 or 99215). It replaces CPT 99417 for Medicare. In 2026 it pays about $34.07 non-facility (1.02 total RVUs times the $33.4009 conversion factor).
- Code type
- Medicare prolonged E/M add-on (per 15 min)
- 2026 non-facility
- $34.07 (1.02 RVUs)
- 2026 facility
- $27.39 (0.82 RVUs)
- Commercial equivalent
- CPT 99417
What is HCPCS G2212 used for?
G2212 is Medicare's prolonged services add-on for office and outpatient E/M. It reports each additional 15 minutes of physician or QHP time beyond a level-5 visit (99205 or 99215) chosen by total time. Functionally it is Medicare's substitute for CPT 99417, created in the 2021 Medicare Physician Fee Schedule final rule.
Like 99417, it is time-based only: the base visit must be leveled by total time, never by MDM, and the code applies exclusively to level-5 outpatient E/M. You must reach a full 15-minute increment before adding a unit, and G2212 and 99417 are never reported together on the same date, because they are alternatives for different payers.
How much does G2212 pay in 2026?
G2212 carries 1.02 non-facility RVUs and 0.82 facility RVUs. At the 2026 conversion factor of $33.4009 that is about $34.07 non-facility and $27.39 in a facility per 15-minute unit. Medicare pays 80 percent of the allowed amount after the deductible; the patient or secondary owes the 20 percent coinsurance. Model a full complex visit with the Medicare fee calculator.
How does G2212 differ from 99417?
Same clinical idea, different trigger time and payer. CMS set G2212 to start at 15 minutes beyond the maximum time of the base code, while CPT 99417 starts 15 minutes beyond the minimum:
| Base code | G2212 trigger (Medicare, per 2021 rule) | 99417 trigger (commercial) |
|---|---|---|
| 99205 | 89 minutes total | 75 minutes total |
| 99215 | 69 minutes total | 55 minutes total |
Example: a Medicare patient seen for a time-based 99215 lasting 72 minutes clears Medicare's 69-minute trigger, so you add one G2212 for about $34.07 on top of the base visit. The identical encounter for a commercial patient would instead carry 99417, which triggers earlier at 55 minutes.
Frequently asked questions
Bill G2212 to Medicare only with a level-5 outpatient E/M (99205 or 99215) selected by total time, for each additional 15 minutes beyond the code's time. Per the 2021 MPFS final rule, CMS set the trigger at 15 minutes beyond the maximum time of the base code. Do not report G2212 on the same date as CPT 99417.
The 2026 national non-facility allowed amount is about $34.07 (1.02 total RVUs times $33.4009) and about $27.39 in a facility (0.82 RVUs), per 15-minute unit. Medicare pays 80 percent after the deductible; the patient or secondary owes the 20 percent coinsurance.
CMS disagreed with the CPT time threshold for prolonged services and created G2212 to trigger at 15 minutes beyond the maximum time of the base code rather than beyond the minimum. It assigns CPT 99417 an invalid status. That is why Medicare claims must carry G2212 and commercial claims typically carry 99417.
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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