G2211 FQHC Medicare

[HGILHAM]

Hello, any FQHC billers/coders getting paid on G2211 from Medicare? I am getting denials stating missing/incomplete/invalid revenue code, do you know what the correct revenue code would be? Would this be included in the PPS rate? I am looking for concrete resources, your help is greatly appreciated.

Thank you,

 

[TThivierge]

Hi There HGILHAM
The HCPCS code G2211 add on code is not to be billed with outpatient and clinic but for a long term care problem and must be complex. Public feedback has not been good on this HCCS code so made modify conditions on it and budget constraints. Try and visit https://www.cms/.goc. I read this in the BC Advantage Billing journal March/April 2024 pg 9
I hope this data has helped you
Lady T

 

[HGILHAM]

Hi There HGILHAM
The HCPCS code G2211 add on code is not to be billed with outpatient and clinic but for a long term care problem and must be complex. Public feedback has not been good on this HCCS code so made modify conditions on it and budget constraints. Try and visit https://www.cms/.goc. I read this in the BC Advantage Billing journal March/April 2024 pg 9
I hope this data has helped you
Lady T

Hello Lady T,

Do you work for a FQHC? I bill out G2211 with E/M codes quite often. We are a clinic. G2211 is an add on code. We have been very successful in receiving payment from other payers.

G2211 - 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).

Thank you for your response.

 

[TThivierge]

Hi Heather
Well I got this data from the journal listed. However are the Dx code billed as unspecified diagnosis? Payers not covering unspecific dx as much. Or it could be when billed Z codes as primary dx. Most Z dx codes are not primary dx codes. Years ago I use to work at a FHQC facility (specialized in beh.health) . However things do change. Maybe the denials are due clinical staff not documenting the patients' comobidities, forever codes, chronic conditions, being detailed in dx levels or the combination dx codes or using appropriate Z dx codes as last? You could audit this at your facility to see type of denial or lack of payment. I hope this data helps you
Lady T

 

[cnjacobs15]

Are you receiving additional reimbursement from Medicare or any of the payers? We opted against billing G2211 due to the lack of revenue. We are not going to get paid any additional amount and it is bundled into our PPS rate..

 

[tadapoof]

Hello Lady T,

Do you work for a FQHC? I bill out G2211 with E/M codes quite often. We are a clinic. G2211 is an add on code. We have been very successful in receiving payment from other payers.

G2211 - 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).

Thank you for your response.

Hi Heather and Lady T,
I work for a small tribal clinic and I'm dealing with Medicare denials on this code. As of now, I think we've only had one instance where the code has been accepted and that was from UMR. According to this article,

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/evaluation-management/G2211-what-it-is-and-how-to-use-it.html

since FQHC's get an encounter rate we shouldn't use G2211. But is that only for Medicaid claims? Obviously we're not billing the same encounter rate to private insurers. My providers we're very excited when it was announced this code was finally going to be available, I hate telling them that we can't use it because insurances won't cover it. The fact is some patients just require more time and resources that providers don't feel like they or the clinics are getting compensated for.
If someone has some updated information about this code, I would love to here about it.

Tracie