Wiki G2211 with PHQ2 and TCM

[kimoylf@gmail.com]

Good morning all - I have had providers asking if they are able to bill the G2211 with a PHQ9 and this was the response from our RCM team. I would be curious is you all agree?
Also can it be billed when completing a TCM?

For Medicare patients, depression screening is only covered annually with code G0444. It is a time-based code and the provider has to document that at least 5 minutes was spent on depression screening. If G0444 is reported with an E/M service, modifier 25 is required, so G2211 will not be covered.

For commercial payers, we generally use code 96127 for depression screening and based on CCI edits there is not a need for modifier 25 when billed with an E/M service. However, payer policies might vary on this (some might require a modifier) and whether or not they pay for the G2211 in this situation or at all

thanks in advance

 

[rthomas@impcna.com]

Good morning all - I have had providers asking if they are able to bill the G2211 with a PHQ9 and this was the response from our RCM team. I would be curious is you all agree?
Also can it be billed when completing a TCM?

For Medicare patients, depression screening is only covered annually with code G0444. It is a time-based code and the provider has to document that at least 5 minutes was spent on depression screening. If G0444 is reported with an E/M service, modifier 25 is required, so G2211 will not be covered.

For commercial payers, we generally use code 96127 for depression screening and based on CCI edits there is not a need for modifier 25 when billed with an E/M service. However, payer policies might vary on this (some might require a modifier) and whether or not they pay for the G2211 in this situation or at all

thanks in advance

I attached the most recent MLN from Medicare. Hope it helps.

 

[TThivierge]

Hello Kimoy
I would not bill G2211 with trans care mgnt TCM , do not add modifier 25 if done with other Evl Mgn CPT codes. Also do not bill the G2211 with annual preventive visits. Id use the depression eval for depresson96127 but not with G2211. However G2211 is used with chronic ongoing care but visit complexity. Visit complexity will be the provider s documentation in o defining that according to what is happening in the patient s treatment.
I hope helped you a little bit more.
Lady T

 

[Courtcle]

Good morning all - I have had providers asking if they are able to bill the G2211 with a PHQ9 and this was the response from our RCM team. I would be curious is you all agree?
Also can it be billed when completing a TCM?

For Medicare patients, depression screening is only covered annually with code G0444. It is a time-based code and the provider has to document that at least 5 minutes was spent on depression screening. If G0444 is reported with an E/M service, modifier 25 is required, so G2211 will not be covered.

For commercial payers, we generally use code 96127 for depression screening and based on CCI edits there is not a need for modifier 25 when billed with an E/M service. However, payer policies might vary on this (some might require a modifier) and whether or not they pay for the G2211 in this situation or at all

thanks in advance

I agree with your RCM team that you cannot bill G2211 if the other codes billed will require a 25 modifier.

G2211 and Modifier 25G2211 may not be reported without reporting an associated O/O E/M visit. G2211 isn’t payable when the associated O/O E/M visit is reported with modifier 25, per MLN MM13473; see attached.

 

[vidraj]

Good morning all - I have had providers asking if they are able to bill the G2211 with a PHQ9 and this was the response from our RCM team. I would be curious is you all agree?
Also can it be billed when completing a TCM?

For Medicare patients, depression screening is only covered annually with code G0444. It is a time-based code and the provider has to document that at least 5 minutes was spent on depression screening. If G0444 is reported with an E/M service, modifier 25 is required, so G2211 will not be covered.

For commercial payers, we generally use code 96127 for depression screening and based on CCI edits there is not a need for modifier 25 when billed with an E/M service. However, payer policies might vary on this (some might require a modifier) and whether or not they pay for the G2211 in this situation or at all

thanks in advance

Hi Kimoy,
"Can we bill G2211 along with TCM" - Were you able to find additional details on this?

 

[rachaelwilleford]

Has to be an O/O E/M visit and 25 modifier cannot be appended. It's in the MLN article and the 2024 Physician Fee Schedule Final Rule.

 

[vidraj]

Thank you for clarifying Rachael.

I just realized that it is specific for the Office/Outpatient E/M. It is all over the article. Guess it's one of those days for me!lol.

Adding here for everyone's reference :"All medical professionals who can bill office and outpatient (O/O) evaluation and management(E/M) visits (CPT codes 99202-99205, 99211-99215), regardless of specialty, may use the codewith O/O E/M visits of any level".