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Stacey LaCottiJan 8, 2024 4:58:13 PM2 min read

New Medicare E/M Complexity Add-On Code G2211

What is CPT Code G2211?

Beginning January 1, 2024, Medicare is implementing CPT code G2211 which is an add-on code that represents the additional time and complexity involved in providing office or other outpatient evaluation and management (E/M) services. It is used as an add-on to E/M CPT codes 99202 through 99215.

Purpose and Benefits

The primary purpose of CPT code G2211 is to capture the increased work and resources required by healthcare providers when managing complex patients. This code helps ensure appropriate reimbursement for the time and effort spent on patients with intricate medical conditions.

By using CPT code G2211, healthcare professionals can accurately document and report the complexity of an encounter, allowing for a more comprehensive understanding of the patient's condition. This information is invaluable for research, quality improvement initiatives, and resource allocation within healthcare systems.

Applicability and Guidelines

CPT code G2211 is intended for use by healthcare professionals across various specialties who provide E/M services to complex patients with consistency and continuity over a long period of time. CMS encourages a longitudinal relationship between the practitioner and the patient. It is not intended to be used when the patient relationship is considered routine or happens over a limited time.

To report CPT code G2211, the following criteria must be met:

  • The primary reason for the visit must be a significant, separately identifiable E/M service
  • The encounter must involve a complex patient, characterized by multiple chronic conditions or significant comorbidities
  • The provider must spend additional time, beyond that typically required for the E/M service, in the assessment and management of the patient
  • Code is not payable on the same date of service as another office/outpatient E/M visit reported with modifier 25, for the same patient by the same physician or non-physician practitioner (codes 99202-99205, 99211-99215)

It is important to remember that CPT code G2211 is not intended for routine encounters or situations devoid of complexity. Documentation must accurately reflect the level of complexity and the additional time spent on the encounter to support the use of this code.


CPT code G2211 serves as a valuable tool for healthcare professionals to accurately capture the complexity and additional time involved in managing complex patients over a long period of time. By using this code appropriately, providers can ensure proper reimbursement and contribute to the overall understanding of patient care complexities.

Alpha II reviews every charge for coding completeness and accuracy. We already have an edit built into our system for this new code. Contact us for more information today.


Stacey LaCotti

Stacey LaCotti has worked in healthcare for over 22 years. Her prior experience in Provider Education for both a large Medicare payer and the Veteran’s Administration provides a unique perspective on ever-changing healthcare policies, with a specialized focus on quality reporting. Stacey uses her knowledge of Alpha II’s coding, claims editing, quality reporting, and revenue cycle solutions to design, educate, and further improve the customer experience.