Edits to Prevent Payment of G2211 with O/O E/M Visit and Modifier 25

Related CR Release Date: November 21, 2023
Effective Date: January 1, 2024
Implementation Date: January 2, 2024
MLN Matters Number: MM13272
Related Change Request (CR) Number: CR 13272
Related CR Transmittal Number: R12370CP

CR 13272 tells you that::

  • Medicare pays separately starting January 1, 2024
  • CMS won’t pay when you report an associated Office/Outpatient Evaluation and Management (O/O E/M) visit with modifier 25
  • CMS won’t pay Method II Critical Access Hospitals on the same encounter for type of bill 85X

Make sure your billing staff knows about complexity add-on code G2211.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)13272.

Last Updated Dec 07 , 2023