Thank you so much for the summary and explanation of code G2211. I am wanting to implement using it right away, but my billers are more hesitant. From what they have looked up, it will go toward co-insurance, deductible, or parent responsibility for many of our private insurance patients. They are afraid of the push back from parents and complaints about this new “additional fee” for care of chronic or complex conditions and might make them less likely to come in for ADHD recheck, asthma rechecks, etc. What are other offices finding when it has been billed on private insurances and are families complaining about the charge?
G2211 Update - Tricare TRICARE does not accept CPT code G2211 - News
On January 1, 2024, Medicare implemented CPT code G2211, which is an add-on code representing 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.
However, TRICARE does not accept the code and it is on our Government No Pay list as of January 1, 2021. Using code G2211 will cause claims to deny and create balance-billing concerns.
Thank you so much for all that you do. You are an inspiration for our practice. Not only are we combating the Change debacle, but many of the practices in our area are selling to corporate management companies. There are only a handful of independent practices in our area when previously 90% were. I agree we all have PTSD and battle fatigue from the constant barrage of prolonged and extremely impactful negative experiences. It feels that we haven’t had a reprieve to experience any of the positives in life. But then, I realize how grateful I am to have shelter, food, and an occupation. Many people these days do not.
I’ve been looking up CPT G2211 AT BlueCross BlueShield website for fee schedule and “Not Found”. MD Medicaid program’s fee schedule is $16.82. Tricare requires a referral.