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HCPCS G2211 · Level II · G code

G2211: Complex E/M visit add on, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G2211

Medicare payment
$17.37
PFS non-facility, national; facility $14.36
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G2211 reads "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 home or residence or office/outpatient evaluation and management service, new or established)" in the October 2026 file; it dates from 2021. Under the 2026 physician fee schedule (October release) G2211 carries 0.33 work, 0.17 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $17.37 non-facility and $14.36 facility before the locality adjustment. Qualifying APM participants get $17.46 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). G2211 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 18 primary codes such as 99202, 99203, 99204, 99205. G2211 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS Z2 (not assigned to a BETOS category); pricing indicator 00; type of service 1 (medical care). Nearby codes: G2212, G2214, G2250, G2251.

G2211 descriptor and code status

The October 2026 HCPCS Level II file describes G2211 as “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 home or residence or office/outpatient evaluation and management service, new or established)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G2211 CPT code", G2211 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G2211
FieldValue
Short descriptorComplex e/m visit add on
Added to HCPCS2021-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator00: not separately priced by Part B
BETOS categoryZ2: not assigned to a BETOS category
Type of service1: medical care

Medicare payment for G2211

Under the 2026 physician fee schedule (October release) G2211 carries 0.33 work, 0.17 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $17.37 non-facility and $14.36 facility before the locality adjustment. Qualifying APM participants get $17.46 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period ZZZ (add-on service inside the primary service's global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G2211
ComponentNon-facilityFacility
Work RVU0.330.33
Practice expense RVU0.170.08
Malpractice RVU0.020.02
Total RVUs0.520.43
National payment (CF $33.4009)$17.37$14.36
Qualifying APM participant (CF $33.5675)$17.46$14.43
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.

Medically Unlikely Edits for G2211

CMS publishes no MUE for G2211 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for G2211 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G2211 in v323r0.

G2211 is an add-on code: it is payable only with a primary service on the same claim (99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99341, 99342, 99344, and others). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G2211 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G2211

No current LCD or billing and coding article lists G2211. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G2211 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G2211

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G2211 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G2211 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G2211

What does HCPCS code G2211 describe?

"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 home or residence or office/outpatient evaluation and management service, new or established)" (short descriptor "Complex e/m visit add on"), in the G section (procedures and professional services, temporary). Added 2021-01-01; last action N (no maintenance) effective 2026-01-01.

Is G2211 a CPT code?

No. G2211 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G2211 CPT code" mean this Level II code.

What does Medicare pay for G2211?

Under the 2026 physician fee schedule (October release) G2211 carries 0.33 work, 0.17 practice-expense and 0.02 malpractice RVUs, which at $33.4009 per RVU pays $17.37 non-facility and $14.36 facility before the locality adjustment. Qualifying APM participants get $17.46 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G2211 an add-on code?

G2211 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 18 primary codes such as 99202, 99203, 99204, 99205.

Does Medicare cover G2211?

G2211 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Can G2211 be billed as telehealth?

Yes. G2211 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.