G2211 HCPCS code: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
G2211 is the HCPCS Level II code for visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established). In 2024 Medicare paid an average of $12.01 per service for G2211 across 24,966,114 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. In 2024, about 226,051 clinicians billed Medicare for G2211 for 10,875,821 beneficiaries; California, Florida, New York accounted for 23% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2021-01-01 |
| Last action effective | 2021-01-01 |
Who bills G2211 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 226,051 |
| Medicare beneficiaries | 10,875,821 |
| States with claims | 59 |
| Share of services in top 3 states (California, Florida, New York) | 23% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G2211, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 24,966,114 | 10,875,821 | $15.87 | $12.01 |
States with the most G2211 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 2,131,468 | $13.16 |
| Florida | 1,936,211 | $12.27 |
| New York | 1,601,384 | $13.29 |
| Texas | 1,597,484 | $11.71 |
| Pennsylvania | 1,310,024 | $11.88 |
What changed for G2211
- 2021-01-01: G2211 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G2211?
G2211 is the HCPCS Level II code for visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established). Short descriptor: "Complex e/m visit add on".
How much does Medicare pay for G2211?
In 2024, the average Medicare payment was $12.01 per service (average allowed $15.87).
Does Medicare cover G2211?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G22 codes
- G2200 — Patient identified as an unhealthy alcohol user received brief counseling
- G2201 — Documentation of medical reason(s) for not providing brief counseling (e.g., limited life expectancy, other medical reasons)
- G2202 — Patient did not receive brief counseling if identified as an unhealthy alcohol user
- G2203 — Documentation of medical reason(s) for not providing brief counseling if identified as an unhealthy alcohol user (e.g., limited life expectancy, other medical reasons)
- G2204 — Patients between 45 and 85 years of age who received a screening colonoscopy during the performance period
- G2205 — Patients with pregnancy during adjuvant treatment course
- G2206 — Patient received adjuvant treatment course including both chemotherapy and her2-targeted therapy
- G2207 — Reason for not administering adjuvant treatment course including both chemotherapy and her2-targeted therapy (e.g. poor performance status (ecog 3-4; karnofsky <=50), cardiac contraindications, insufficient renal function, insufficient hepatic function, other active or secondary cancer diagnoses, other medical contraindications, patients who died during initial treatment course or transferred during or after initial treatment course)
- G2208 — Patient did not receive adjuvant treatment course including both chemotherapy and her2-targeted therapy
- G2209 — Patient refused to participate
- G2210 — Residual score for the neck impairment not measured because the patient did not complete the neck fs prom at initial evaluation and/or near discharge, reason not given
- G2212 — Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
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Next steps
- Run a reimbursement report for a device billed under G2211
- Watch G2211 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G2211
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.