G2211 is an HCPCS add-on code introduced in the 2024 Physician Fee Schedule Final Rule. It allows providers to bill for the additional complexity and effort involved in delivering longitudinal, comprehensive primary care during an Evaluation and Management (E&M) visit for Medicare patients. In the 2025 PFS Final Rule, CMS expanded the use of G2211 to include Medicare Annual Wellness Visits (AWVs), making it a topic of significant interest among healthcare providers. Here’s a breakdown of what you need to know about G2211 and its implications for your practice.
What is G2211?
G2211 is designed to capture the inherent complexity of a visit that arises from the ongoing, longitudinal relationship between a provider and their patient. It can be billed when a provider serves as the focal point of care for a patient, particularly when managing serious or complex conditions. Importantly, no specific diagnosis is required to bill G2211, but the provider must demonstrate a commitment to overseeing the patient’s care consistently over time.
For example, if a patient visits their primary care provider (PCP) for an acute issue like influenza, and the provider also addresses the patient’s chronic condition (e.g., diabetes management) during the same visit, G2211 may be billed. However, if the patient is seeing the provider for the first time and only receives care for the acute issue, G2211 would not apply.
Reimbursement for G2211
The national average reimbursement rate for G2211 is approximately $16, though this varies by state. It can be billed alongside CPT codes 99202-99205 and 99211-99215 for E&M visits. Starting in 2025, G2211 can also be billed with Medicare Annual Wellness Visits (G0438 and G0439). To ensure reimbursement, medical documentation must reflect that the provider addressed a complex or serious condition during the visit, in addition to the services provided during the AWV or E&M visit.
Why G2211 Matters
G2211 reflects CMS’s commitment to supporting providers who deliver ongoing, personalized care to Medicare patients. It acknowledges the effort involved in building long-term patient relationships and developing comprehensive care plans. By using G2211, providers can enhance their Medicare reimbursements while continuing to strengthen patient-provider relationships.
G2211 vs. Advanced Primary Care Management (APCM)
Some providers have questioned whether G2211 overlaps with CMS’s Advanced Primary Care Management (APCM) program. While both emphasize longitudinal care and care planning, they serve different purposes. G2211 is an add-on code for E&M visits, applicable only when the provider sees the patient during an appointment and addresses ongoing care needs. In contrast, APCM focuses on care management services provided between visits, often by care managers or nurses under the provider’s supervision.
APCM also has additional requirements, such as offering 24/7 care lines, digital communication options, alternate care delivery methods (e.g., home visits), and transitional care services. G2211, on the other hand, is limited to the care provided during in-office visits and does not require these additional capabilities.
Changes to G2211 in 2025
In 2025, CMS expanded the use of G2211 to include Annual Wellness Visits (G0438 and G0439). This change enhances the value of AWVs for both patients and providers. Patients can now receive preventive care, discuss their Health Risk Assessment results, and address ongoing conditions in a single visit. For providers, adding G2211 to AWVs increases reimbursement rates—for example, G0438 reimbursement rises from $173 to $189, and G0439 increases from $117 to $133.
Key Takeaways
G2211 is part of CMS’s broader effort to reimburse providers for the work involved in establishing and maintaining long-term patient relationships and managing complex conditions. It is distinct from care management programs like APCM or Chronic Care Management (CCM), which focus on services provided between visits. G2211 is specifically for in-office E&M visits where the provider addresses both acute and chronic care needs.
By incorporating G2211 into your practice, you can improve patient care, strengthen patient-provider relationships, and enhance reimbursement for the comprehensive services you provide.
