January 11, 2021
ADD-ON CODE FOR VISIT COMPLEXITY
Medicare established payment for HCPCS add-on code G2211 describing visit complexity
inherent to office/outpatient E/M visits 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.
HCPCS 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, or complex condition. (Add-on code, list separately in addition to office/outpatient
evaluation and management visit, new or established)).
The Consolidated Appropriations Act delays PFS payment for this code until January 1, CY
2024 or later. Practitioners may report this code for qualifying visits furnished on or after
January 1, 2021, although we assigned a PFS payment status indicator of “B” (Bundled) until
2024.
• HCPCS code G2211 includes services that enable practitioners to build longitudinal
relationships with all patients (that is, not only those patients who have a chronic
condition or single-high risk disease) and to address the majority of patients’ health care
needs with consistency and continuity over longer periods of time. This includes
furnishing services to patients on an ongoing basis that result in care that is personalized
to the patient. The services result in a comprehensive, longitudinal, and continuous
relationship with the patient and involve delivery of team-based care that is accessible,
coordinated with other practitioners and providers, and integrated with the broader health
care landscape.
• Reporting is not restricted based on specialty, but certain specialties will likely furnish
these types of visits more than other specialties. HCPCS code G2211 may be reported
with any visit level.
• Example 1: In the context of primary care, HCPCS code G2211 could recognize the
resources inherent in holistic, patient-centered care that integrates the treatment of illness
or injury, management of acute and chronic health conditions, and coordination of
specialty care in a collaborative relationship with the clinical care team.
• Example 2: In the context of specialty care, HCPCS code G2211 could recognize the
resources inherent in engaging the patient in a continuous and active collaborative plan of
care related to an identified health condition the management of which requires the
direction of a clinician with specialized clinical knowledge, skill and experience. Such
collaborative care includes patient education, expectations and responsibilities, shared
decision-making around therapeutic goals, and shared commitments to achieve those
goals.