Complexity Add-on Code G2211

Complexity add-on code G2211 may be submitted with Evaluation and Management (E/M) office or outpatient (O/O) visits (codes 99202-99215). Beginning in 2026, G2211 will also apply to home or residence E/M visits (codes 99341-99350).

G2211 recognizes services that enable practitioners to establish and maintain longitudinal relationships with patients (not only those patients who have a chronic condition or single, high-risk disease) and to address most health care needs with consistency and continuity over longer periods of time.

Documentation

Documentation demonstrates services are furnished on an ongoing basis, resulting in care personalized to the patient. These services reflect a comprehensive, continuous relationship and involve team-based care that is accessible, coordinated across practitioners and providers, and integrated within the broader health care landscape.

  • Must show services furnished on an ongoing basis
  • Care plan is personalized, comprehensive and continuous
  • Indication of complexity
    • Provider serves as primary point of contact for managing health care long-term
    • Builds a trusting relationship with the patient
    • Manages care for ongoing or complex condition(s) (specific diagnosis not required)
  • Templated language may not adequately support medical necessity for G2211 as each patient's needs are unique with their health care needs
  • Depending on the situation, once a year visit without a care plan for an ongoing condition, may unlikely qualify for G2211.

The code does not limit the type of provider based on specialties.

Code descriptor

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 or outpatient E/M visit, new or established)

E/M with Modifier -25
Separately identifiable E/M visits billed with modifier -25 occurring on the same day as a minor procedure, have resources sufficiently distinct from the costs associated with that reimbursement. CMS will not allow payment for the add-on code G2211 when the E/M service is billed with modifier 25.
Refer to MLN 13272 in resources.

Certain Preventive Services Billed
Effective January 2025, when separately identifiable O/O E/M visits include modifier -25 and are billed on the same day as certain preventive services identified in Change Request (CR) 13705, HCPCS code G2211 may be reimbursed when documentation is supported in the medical record. Preventive services include Annual Wellness Visit (AWV), Initial Preventive Physical Exam (IPPE), and other identified preventive services.

Examples included in CR13452
Example 1: A patient has a primary care practitioner that is the continuing focal point for all health care services, and the patient sees this practitioner to be evaluated for sinus congestion. The inherent complexity that this code (G2211) captures is not in the clinical condition itself - sinus congestion - but rather the cognitive load of the continued responsibility of being the focal point for all needed services for this patient. There is previously unrecognized but important cognitive effort of utilizing the longitudinal relationship itself in the diagnosis and treatment plan and weighing the factors that affect a longitudinal doctor patient relationship.

In this example, the primary care practitioner could recommend conservative treatment or prescription of antibiotics. If the practitioner recommends conservative treatment and no new prescriptions, some patients may think that the doctor is not taking the patient’s concerns seriously and it could erode the trust placed in that practitioner. In turn, an eroded primary care practitioner-patient relationship may make it less likely that the patient would follow that practitioner’s advice on a needed vaccination at the next visit. The primary care practitioner must decide, what course of action and choice of words in the visit itself, would lead to the best health outcome in this single visit, while simultaneously building up an effective, trusting longitudinal relationship with this patient for all their primary health care needs. Weighing these various factors, even for a seemingly simple condition like sinus congestion, makes the entire interaction inherently complex, and it is this complexity in the relationship between the doctor and patient that this code captures.

Example 2: A patient with HIV has an office visit with their infectious disease physician, who is part of ongoing care. The patient with HIV admits to the infectious disease physician that there have been several missed doses of HIV medication in the last month. The infectious disease physician has to weigh their response during the visit, the intonation in their voice, the choice of words to not only communicate clearly that it is important to not miss doses of HIV medication, but also to create a sense of safety for the patient in sharing information like this in the future. If the interaction goes poorly, it could erode the sense of trust built up over time, and the patient may be less likely to share their medication adherence shortcomings in the future. If the patient isn’t forthright about their medication adherence, it may lead to the infectious disease physician switching HIV medicines to another with greater side effects, even when there was no issue with the original medication. It is because the infectious disease physician is part of ongoing care, and has to weigh these types of factors, that the E/M visit becomes inherently more complex, and the practitioner bills code G2211. Even though the infectious disease doctor may not be the focal point for all services, such as in the previous example, HIV is a single, serious condition, and/or a complex condition, and so as long as the relationship between the infectious disease physician and patient is ongoing, this E/M visit could be billed with the add-on.

To reiterate, the most important information used to determine whether the add-on code could be billed is the relationship between the practitioner and the patient. If the practitioner is the focal point for all needed services, such as a primary care practitioner, the HCPCS G2211 add-on code could be billed. Or, if the practitioner is part of ongoing care for a single, serious and complex condition (e.g., sickle cell disease), then the add-on code could be billed. The add-on code captures the inherent complexity of the visit that is derived from the longitudinal nature of the practitioner and patient relationship.

Resources

Last Updated Dec 31 , 2025