Wiki G2211 w/Telemed

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KoBee

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Hello

Does anyone know if G2211 can be billed with NEW telemed visit 98000-98015?
 
KoBee said:
Hello

Does anyone know if G2211 can be billed with NEW telemed visit 98000-98015?
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Hi there, you can only report it with an office/other outpatient codes. It's in the full descriptor.
 
Can you please cite where you found this? To my knowledge, G2211 may be billed with new patient E&M codes whether in person or via telehealth, as long as the provider can support intent of a longitudinal relationship. I would be interested to know where you got this information.
 
I think the issue about whether or not G2211 can be billed with 98000-98015 is that G2211 is a Medicare code (also recognized by a few commercial carriers), but Medicare is NOT recognizing 98000-98015.
G2211 description: 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/outpatient evaluation and management visit, new or established)
It does not list the exact CPTs as the primary, but does state new or established office/outpatient E/M. I would interpret that as you may use G2211 with 98000-98015. However, the amount of carriers that will both accept G2211 and also accept the new telehealth codes 98000-98015 may be zero.
 
jkyles said:
Sure thing, here you go: https://www.cms.gov/files/document/hcpcs-g2211-faq.pdf




If someone reports a telehealth visit with an office/outpatient code, which is the only option for Medicare and some private payers, they can (I think) report G2211 with it. I'm pretty sure the add-on is on the CMS telehealth list but I don't have it handy.

But G2211 can't currently be reported with any other primary code (CMS has proposed adding home/residence visits in 2026).
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My interpretation still stands that Medicare will never list 98000-98015 as Medicare does not recognize those codes. If I had a unicorn of a payor that wanted and recognized 98000-98015 for telehealth, and accepted G2211, I believe coding them together would be permissible per coding guidelines (not Medicare guidelines). I am not aware of any such payor.
 
Right, I don't think we're in disagreement. As requested I provided a source to back up my statement that G2211 is only reported with the O/O codes. CMS does cover the 992## codes as telehealth services (and I just dug out the list and G2211 is included). So someone could report 99204, G2211 via telehealth, for example. But Medicare lists the telemed codes as Invalid and just restated that it isn't covering them.

To get back to the original question, I do think people are understandably confused by the new telemed services because the CPT manual describes them as substitute office visits or something and the full descriptor for G2211 just says office/other outpatient. But the CPT Editorial Panel isn't reimbursing claims so a telemed/G2211 combo isn't getting paid. Unless unicorn appears. 🦄
 
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@jkyles, There was an earlier comment (since deleted) that indicated that G2211 could not be reported with new patient E&M codes. I did not believe that to be true, and I'm guessing the poster figured out that as well! Thanks for the info, though!
 
thank you so much for you response

I understand Medicare is not accepting new telemed codes 98000-98015, we are using 99202-92015 with modifier 95/93 for telemed. But can we bill G2211 in this scenario ?

example:
99213-95
G2211

for commercial payers who want to use new telemed codes 98000-98015, is G2211 even allowed with those? I noticed for G2211 there is no modifier 95 allowed only 93 under AAPC codify. So makes me think then G2211 should not be coded/billed with 98000-98015.
 
Hi there.
1. For Medicare, almost. You need to use the correct place of service (02 or 10) not a modifier.
2. In my opinion, which is based on the descriptor for G2211 and Medicare guidance: No. But you'll need to look at each payer's policy to be 100% sure.


I think it is strange that G2211 is flagged as an audio-only code. It certainly isn't on the CPT manual's list of audio-only codes.
 
jkyles said:
Hi there.
1. For Medicare, almost. You need to use the correct place of service (02 or 10) not a modifier.
2. In my opinion, which is based on the descriptor for G2211 and Medicare guidance: No. But you'll need to look at each payer's policy to be 100% sure.


I think it is strange that G2211 is flagged as an audio-only code. It certainly isn't on the CPT manual's list of audio-only codes.
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That is why it was throwing me off a little. There are payers who are accepting the new telemed codes but unsure about adding G2211. Not many resources as of yet regarding this code combination.
 
Right, that's why you have to look at what each payer is doing (or ask them). To csperoni's point, a payer COULD decide to cover G2211 that way, but I'd want it in writing from each payer, either in a policy or a answer to a question from a rep. Because Medicare created G2211 and doesn't cover the telemed codes I don't think we'll be getting any official resources on that combo.
 
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