Wiki G2211 Question

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kgrinnell

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We have recently started billing G2211 with office visit E&M code. Regardless of using modifier 25 or not on the E&M, we are getting the same denials stating: G2211 is not paid separately or Service not payable with other service rendered on the same date or incidental to other procedure. We are a Pulmonology Specialty office.
 
G2211 was created by and payable by Medicare. Commercial carriers each may have their own guidelines about whether or not G2211 is payable or bundled.
 

Another example of - read and know your health plan policies before starting to try to bill services. :)

Example: https://www.uhcprovider.com/content...comm-reimbursement/COMM-Rebundling-Policy.pdf
Q: Will UnitedHealthcare Commercial and Individual Exchange allow separate reimbursement for codes G2211and G0545 for visit complexity when billed on the same date of service for the same patient by the same physician or Other QHP with an Evaluation and Management Service? A: No, visit complexity for services G2211 and G0545 are structured in the reimbursement for evaluation and management services and not paid separately
Example: https://www.anthem.com/content/dam/...cial/general/bundled-services-section-one.pdf
 
I agree with the comments from Christine and Amy. Once we got past the hurdle of training the physicians that G2211 can't be billed if a patient is schedule for infusion room services, the next one was the payer coverage. We have found a few commercial plans will cover G2211 but most do not. The payer's bundling policies are generally a good resource for these questions. We went through all of our major payers policies to check coverage before we began using the code so we'd know what to expect as our claims processed.
 
Are there any medicare or MA plans actually paying for this? I realize they can now with E/M with 25 modifier and certain preventable part B services, but anyone actually getting reimbursed?
Has G2211 come up in any audits? To me this could be a documentation red flag.
 
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