Can G2211 be billed with Medicare Wellness Visit?

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Yes, you can use add-on code G2211 alongside a Medicare Annual Wellness Visit (AWV), but you must bill it with a separate, qualifying office or outpatient evaluation and management (E/M) code using modifier 25.

Key Billing Requirements

  • Base Code Needed: G2211 cannot be attached directly to an AWV code (like G0438 or G0439) on its own. It requires a separate office or outpatient E/M visit code (CPT 99202–99215).
  • Modifier 25: You must append modifier 25 to the separate E/M code to indicate that it is a significant, separately identifiable service provided on the same day as the preventive wellness visit.
  • Documentation: Your medical record must clearly support both the separately identifiable E/M service and your ongoing, longitudinal relationship with the patient acting as the continuing focal point for their care.

For official guidance and code specifics, review the CMS MLN Matters Article on G2211 and the AAFP G2211 Update Guide.

Can G2211 be billed with 99395?

HCPCS code G2211 cannot be billed with preventive medicine code 99395 because G2211 requires an eligible office/outpatient evaluation and management (E/M) base code (such as 99202–99205 or 99211–99215) or an approved home/residence E/M code.

Key Billing Rules for G2211

  • Eligible Base Codes: G2211 is strictly an add-on code meant to accompany routine office/outpatient E/M visits (99202–99215) or home/residence visits (99341–99350). It is not an add-on for preventive medicine codes like 99395.
  • Preventive Services Exception: While Medicare allows G2211 alongside an office E/M code billed with modifier 25 when an Annual Wellness Visit (G0438/G0439) or a Medicare Part B preventive service/vaccine is done on the same day, commercial preventive codes (like the 9938x/9939x series) do not support G2211 unless paired with a separately documented, qualifying office E/M visit.
  • Payer Policies: Always verify individual commercial or managed care contracts, as private payers have varying rules regarding G2211 and preventive service bundling.

Can you bill G2211 with Medicare?

Yes, you can bill HCPCS code G2211 to Medicare.

Medicare has reimbursed for this add-on code since January 1, 2024, to cover the extra cognitive and longitudinal workload of complex primary care and ongoing patient relationships.

Billing Rules

  • Base Codes: Pair it with office or outpatient E/M codes (99202–99215) or home/residence services (99341–99350).
  • Payment Amount: The national Medicare average payment is roughly $16.05.
  • Modifier 25: You can report G2211 alongside same-day preventive services or annual wellness visits when appending modifier 25 to the primary E/M code.
  • Exclusions: You cannot bill it in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) where it is bundled into standard rates. It also does not apply to one-time, time-limited, or acute discrete consultations where a long-term care relationship is absent.

Can G2211 be billed with just G0439?

Yes, G2211 can be billed on the same day as an Annual Wellness Visit like G0439, but only if you also perform and bill a separately identifiable office/outpatient evaluation and management (E/M) service with modifier 25 attached.

Key Billing Requirements

  • No Direct Add-On: You cannot attach G2211 directly to the G0439 wellness code alone.
  • The E/M Requirement: There must be a distinct, medically necessary problem-oriented E/M visit (such as CPT codes 99212–99215) performed on the same date.
  • Modifier 25: Append modifier 25 to the separate E/M code to show the service is distinct from the routine wellness exam.
  • Documentation: Your medical record must clearly support the separate E/M service, the longitudinal relationship or ongoing care complexity for G2211, and the wellness visit.

For official guidance and policy details, check the CMS G2211 FAQ or review instructions on the AAPC Blog.

What are the updated CMS guidelines for code G2211 in 2025?

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).

Medicare's G2211 Add-on Code: 2024 Guide + Major 2025 Updates!

9 related questions found

Can you bill G2211 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.

When should G2211 not be used?

You should not use the CMS FAQ for G2211 code when your relationship with the patient is discrete, routine, or time-limited rather than longitudinal or ongoing.

When to Avoid G2211

  • Acute or single-issue visits: Do not use it for a one-off visit for a simple problem like a cold, a minor rash, or a simple mole removal where you do not plan to provide ongoing care.
  • No continuous responsibility: Avoid it if you have not assumed—or do not intend to assume—responsibility for the patient's continuous medical care over time.
  • Urgent care or brief consultations: Do not report it if you are providing a second opinion, a single specialist consultation, or urgent care without any intent to follow up long-term.
  • Certain modifier restrictions: Generally do not bill it alongside an E/M code that uses modifier 25, unless it falls under specific allowed preventive, wellness, or immunization exceptions.
  • Facility restrictions: It cannot be billed when rates are already bundled, such as in certain Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs).

Why is Medicare not paying G2211?

Medicare most commonly denies HCPCS code G2211 when the base office or outpatient evaluation and management (E/M) visit is billed with Modifier 25 for a same-day minor procedure or non-qualifying service.

You can review a breakdown of denial reasons and appeal steps using the guide on Why Is G2211 Being Denied? Causes and Appeals.

Top Reasons for G2211 Denials

  • Modifier 25 Conflicts: Medicare denies G2211 when appended to an E/M visit containing Modifier 25, unless the same-day service is a specific allowed preventive service, vaccine administration, or Annual Wellness Visit (AWV).
  • Incorrect Base Codes: The code requires specific office/outpatient (CPT 99202–99205, 99211–99215) or certain home/residence base codes. Inpatient, emergency department, or urgent care visits do not qualify.
  • Facility Bundling: G2211 is automatically bundled into overall payment rates for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), meaning it cannot be billed separately.
  • Insufficient Documentation: Medical records must clearly support a longitudinal, continuous relationship or the cognitive complexity of serving as the ongoing focal point for the patient's care. Templated or one-off visit notes often fail to meet this standard.

Are G codes still required for Medicare?

G-codes are no longer required for outpatient therapy functional limitation reporting, but they are still required for many other Medicare services.

Outpatient Therapy G-Codes

  • The Rule: Medicare stopped requiring functional limitation G-codes and severity modifiers for physical, occupational, and speech therapy effective January 1, 2019.
  • Current Status: You do not report functional tracking G-codes (or CH-CN modifiers) at evaluation or discharge for Medicare Part B therapy anymore.
  • What's Still Needed: Standard therapy modifiers like GP, GO, and GN are still mandatory on claims.

Where G-Codes Are Still Required

  • Preventive & Wellness Services: Medicare uses specific G-codes for annual wellness visits, screenings, and preventive services that lack standard CPT codes.
  • Telehealth & Special Programs: CMS regularly introduces temporary or permanent G-codes for virtual care, new care management models (such as Advanced Primary Care Management), and specific procedures.
  • Quality Reporting: Certain G-codes remain tied to programs like MIPS (Merit-based Incentive Payment System).

You can check the official Centers for Medicare & Medicaid Services (CMS) HCPCS Level II Coding Process for ongoing updates on active codes.

Can we bill 99214 and G2211 together?

Yes, you can bill CPT code 99214 and HCPCS add-on code G2211 together when the visit involves a longitudinal, continuing relationship and meets Medicare requirements.

Billing Guidelines

  • Base Code: Code 99214 (established patient office/outpatient visit) is an eligible base code for the G2211 complexity add-on.
  • Longitudinal Care: The provider must serve as the continuing focal point for ongoing care or manage a serious/complex condition.
  • Documentation: Your clinical notes must support the ongoing patient-practitioner relationship and the cognitive burden of managing the patient's care over time.

Important Restrictions

  • Modifier 25 Conflict: You generally cannot bill G2211 if you must append modifier 25 to 99214 for a separate, simultaneous procedure on the same day (unless it falls under specific preventive service exceptions like annual wellness visits or vaccines).
  • Payer Policies: G2211 is a Centers for Medicare & Medicaid Services policy; Medicare Advantage follows standard guidelines, but commercial payer acceptance varies.