Can G2211 be billed with an annual wellness visit?

Yes, HCPCS code G2211 can be billed on the same day as a Medicare Annual Wellness Visit (AWV), but it cannot be added directly to the AWV code (such as G0438 or G0439).

Key Billing Requirements

• Requires a Base E/M Code: G2211 is an add-on code. It must be billed alongside an eligible office/outpatient evaluation and management (E/M) code (such as CPT 99202–99205 or 99211–99215).
• Use Modifier 25: When performed on the same date as an AWV, the separately identifiable problem-oriented E/M visit must be appended with Modifier 25.
• Documentation Support: The medical record must clearly document both the separately identifiable E/M service and the longitudinal care complexity or serious/complex condition required for G2211.

You can review official guidelines and updates directly via the CMS G2211 FAQ Document.

HCPCS code G2211 can be billed alongside specific outpatient, office, and home-based Evaluation and Management (E/M) base codes.

Eligible Base Codes

• Office or Outpatient Visits (New Patients): CPT codes 99202, 99203, 99204, and 99205.
• Office or Outpatient Visits (Established Patients): CPT codes 99211, 99212, 99213, 99214, and 99215.
• Home or Residence Visits: CPT codes 99341 through 99350 (for both new and established patients).
• Telehealth Services: Can be billed when the eligible office-based E/M codes are furnished via telehealth.
• Annual Wellness Visits: Medicare Annual Wellness Visits (G0438 and G0439).

Key Billing Rules & Restrictions

• Same-Day Requirement: G2211 must be reported on the same date of service as the primary E/M or wellness visit code.
• Modifier 25 Restrictions: Generally, G2211 cannot be billed if Modifier 25 is appended to the E/M code for a same-day minor procedure or separate service, though exceptions exist for AWVs, vaccines, and certain preventive services.
• Ineligible Settings: It cannot be paired with inpatient hospital care, emergency department visits, nursing facility services, or urgent care visits where a longitudinal, continuous provider-patient relationship does not apply.

For more details on implementation, review the Centers for Medicare & Medicaid Services G2211 FAQ or check guidance via the American Academy of Family Physicians G2211 Guide.

No, HCPCS code G2211 cannot be billed with routine preventive medicine code 99396.

Billing Guidelines & Rules

• Eligible Base Codes: G2211 is an add-on code that requires specific office/outpatient evaluation and management (E/M) base codes (such as CPT 99202–99205 and 99211–99215) or qualifying home/residence visits.
• Exclusions: It is not intended for routine encounters or preventive medicine E/M services like CPT 99381–99397.
• Exceptions: While Medicare allows G2211 alongside certain preventive services like Annual Wellness Visits (G0438, G0439) or vaccinations when paired with a separate qualifying office E/M code, it is not valid for routine periodic preventive physicals represented by code 99396.

Under the updated CMS Physician Fee Schedule for 2025, HCPCS add-on code G2211 can now be billed alongside an office or outpatient Evaluation and Management (E/M) visit using modifier 25 when performed on the same day as specific Medicare Part B preventive services, annual wellness visits (AWV), or vaccine administration.

Core 2025 Updates for G2211

• Modifier 25 Exception: Previously, G2211 was generally denied when billed with modifier 25 on the same date of service. Starting January 1, 2025, CMS allows payment if the same-day service accompanying the E/M visit and modifier 25 is an allowed preventive service, wellness visit, or immunization.
• Eligible Base Codes: Continues to apply to office/outpatient E/M base codes CPT 99202–99205 (new patients) and 99211–99215 (established patients).
• Core Purpose: Recognizes the inherent cognitive load, time, and practice expense of managing longitudinal, comprehensive ongoing care or serving as the continuing focal point for a patient's health needs.

Documentation and Billing Rules

• Medical Necessity: Providers must distinctly document the medical necessity for both the underlying E/M visit (supported by a separate history, exam, or medical decision-making when using modifier 25) and the longitudinal cognitive commitment supporting G2211.
• No Specific Diagnosis Required: A specific complex diagnosis code is not mandatory, but the patient record must clearly show a continuous, trusting, and long-term provider-patient relationship or management of a serious/complex condition.
• Setting Limitations: G2211 remains excluded or bundled under specific alternative payment models like Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs).

Yes, you can bill HCPCS code G2211 with an eligible telehealth evaluation and management (E/M) visit.

Billing Rules for G2211 and Telehealth

• Qualifying base codes: You must pair G2211 with a valid outpatient E/M code (CPT 99202–99205 or 99211–99215) provided via telehealth.
• Standalone prohibition: You cannot submit G2211 by itself; it requires a primary E/M service on the same date of service.
• Longitudinal care: The visit must reflect ongoing, relationship-based care for a complex or serious condition, rather than a one-time or isolated consultation.
• Place of service: Ensure you use the correct telehealth place-of-service code (such as POS 02 or 10) and required modifiers according to current Centers for Medicare & Medicaid Services (CMS) guidance.
• Payer verification: Commercial insurers and Medicare Advantage plans do not follow identical rules and may choose not to reimburse G2211 for telehealth.