US · guidance
CMS Pub. 100-04, ch. 12, § 30.6.19
Office/Outpatient Evaluation and Management (O/O E/M) Complexity
Add-on Payment (Code G2211)
(Rev. 12370; Issued: 11-21-23; Effective: 01-01-24; Implementation: 01-02-24)
Starting on January 1, 2024 O/O E/M visit complexity add-on code, G2211 to describe
intensity and complexity inherent to O/O E/M visits not accounted for in the valuation of the
primary service codes is unbundled and separately payable as an additional payment to the
payment for O/O E/M visit primary service codes (99202-99205, 99211-99215).
The full descriptor, refined in the calendar year (CY) 2021 PFS final rule, is code G2211 (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)). (See the CY 2021 Medicare Physician Fee Schedule
final rule in the Federal Register (85 FR 84571)).
The A/B MACs (A & B) shall not pay code G2211 on the same date of service as an
office/outpatient evaluation and management visit (codes 99202-99205, 99211-99215) reported
with Modifier 25, to the same beneficiary by the same practitioner or nonphysician
practitioner.
History
(Rev. 12370; Issued: 11-21-23; Effective: 01-01-24; Implementation: 01-02-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
28480af0c01b1aacb5e6f727080bdefa17929180b26a57d73ae08a440fe3550d
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