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HCPCS G2212 · Level II · G code

G2212: Prolong outpt/office vis, 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 G2212

Medicare payment
$34.07
PFS non-facility, national; facility $27.39
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
6
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
6
6 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

CMS describes HCPCS G2212, added in 2021, as "Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)". Medicare's October 2026 physician fee schedule pays G2212 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 at $33.5675. MUE limits for G2212: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data). G2212 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 4 primary codes such as 99205, 99215, 99483, G0463. In the NCCI PTP files v323r0 G2212 appears in 0 practitioner pairs as column 2 and 6 as column 1, and in 0 hospital outpatient pairs as column 2 and 6 as column 1. No current LCD or billing article lists G2212; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS M5D (specialist - other); pricing indicator 11; type of service 1 (medical care). Nearby codes: G2211, G2214, G2250, G2251.

G2212 descriptor and code status

The October 2026 HCPCS Level II file describes G2212 as “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G2212 CPT code", G2212 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 G2212
FieldValue
Short descriptorProlong outpt/office vis
Added to HCPCS2021-01-01
Last actionN (no maintenance), effective 2023-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G2212

Medicare's October 2026 physician fee schedule pays G2212 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 at $33.5675. 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 XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G2212
ComponentNon-facilityFacility
Work RVU0.610.61
Practice expense RVU0.360.16
Malpractice RVU0.050.05
Total RVUs1.020.82
National payment (CF $33.4009)$34.07$27.39
Qualifying APM participant (CF $33.5675)$34.24$27.53
  • 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 N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for G2212

MUE limits for G2212: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G2212 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services63 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital63 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G2212 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G2212 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 6 (83% modifier-allowed); 2 earlier pairs have been deleted.

Column-2 codes bundled into G2212 (practitioner)
Column-2 codePairs
99358 (CPT; descriptor licensed by AMA)1
99359 (CPT; descriptor licensed by AMA)1
99415 (CPT; descriptor licensed by AMA)1
99416 (CPT; descriptor licensed by AMA)1
99417 (CPT; descriptor licensed by AMA)1
99418 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G2212 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 6 (83% modifier-allowed); 2 earlier pairs have been deleted.

Column-2 codes bundled into G2212 (hospital outpatient)
Column-2 codePairs
99358 (CPT; descriptor licensed by AMA)1
99359 (CPT; descriptor licensed by AMA)1
99415 (CPT; descriptor licensed by AMA)1
99416 (CPT; descriptor licensed by AMA)1
99417 (CPT; descriptor licensed by AMA)1
99418 (CPT; descriptor licensed by AMA)1

G2212 is an add-on code: it is payable only with a primary service on the same claim (99205, 99215, 99483, G0463). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G2212 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G2212

No current LCD or billing and coding article lists G2212. 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

G2212 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 G2212

CARC 50 · N115

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

CARC 151 · N362

units of G2212 exceed the practitioner MUE of 6 per 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 G2212 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G2212 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 G2212

What does HCPCS code G2212 describe?

"Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)" (short descriptor "Prolong outpt/office vis"), in the G section (procedures and professional services, temporary). Added 2021-01-01; last action N (no maintenance) effective 2023-01-01.

Is G2212 a CPT code?

No: CMS maintains G2212 in HCPCS Level II, while the AMA maintains CPT. People do search "G2212 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G2212?

Medicare's October 2026 physician fee schedule pays G2212 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 at $33.5675.

Is G2212 an add-on code?

G2212 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 4 primary codes such as 99205, 99215, 99483, G0463.

How many units of G2212 can be billed per day?

MUE limits for G2212: practitioner 6 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data). For the practitioner MUE (MAI 3), units above 6 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G2212?

No current LCD or billing article lists G2212; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Can G2212 be billed as telehealth?

Yes. G2212 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.