Wiki G2211

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KoBee

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Is G2211 allowed to be billed annual physical preventive visits for CPT 99393-99397 for current year of 2025.

I know G2211 can be billed alongside CPT Codes 99202-99205 and 99211-99215 & Medicare Annual Wellness Visits G0438 and G0439
 
KoBee said:
Is G2211 allowed to be billed annual physical preventive visits for CPT 99393-99397 for current year of 2025.

I know G2211 can be billed alongside CPT Codes 99202-99205 and 99211-99215 & Medicare Annual Wellness Visits G0438 and G0439
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Hi there, you'll need to look at the specific payer policies.

G2211 is an add-on code for office/other outpatient visits. CMS expanded coverage to allow providers to report the appropriate E/M visit code with modifier 25 and G2211 on the same day as an AWV last year and for 2025 expanded the policy to include all preventive service. However, CMS does not cover the physical exam codes.
 
What if we just bill 99215 with G2211. Should we still be putting modifier 25 on the office visit?
Everything seemed to be paying in the beginning of January and now G2211 is denying for almost everything including office visit with preventives or AWV, screening, etc.
What am I doing wrong here? Lol!
 
taylor.mcgovern@gmail.com said:
What if we just bill 99215 with G2211. Should we still be putting modifier 25 on the office visit?
Everything seemed to be paying in the beginning of January and now G2211 is denying for almost everything including office visit with preventives or AWV, screening, etc.
What am I doing wrong here? Lol!
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No, G2211 is an add-on code for the office E/M visit so 25 wouldn't be necessary. It is only necessary if you're trying to get the office visit/complexity of care visit combo paid on the same day as a preventive service. It's hard to say what might be wrong on your end. It could be your MAC is having some sort of issue. Have you checked with them?
 
klapetri@ilovemygyn.com said:
I have the same question. Also if 99459 could be billed with it? and if G221 can be billed by ob/gyn
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1. G2211 is only allowed as an add-on code to the office/other outpatient visits.

2. It depends on the patient. G2211 is not specialty specific but the provider/patient relationship must meet the code's requirements. Here's the full descriptor:

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)
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So if the ob/gyn acts as PCP for a patient, sure. If they manage a patient with a serious or complex condition, also yes. If it is a patient that they see every once in a while but don't follow over time, no.
 
My claim coded with CPT's G0439, 99214-25, G2211 and 69209. As per 2025 revised guidelines per MLN Matters Number: MM13473, the add on code G2211 is payable even if you report the base code with modifier 25 only when the service or other procedure requiring the reporting of modifier 25 is an allowed Part B services. (https://www.cms.gov/files/document/r13199otn.pdf-0#page=9). In mentioned link G0439 was available but 69209 was not in the list of attachment 1. Now can we remove G2211 or just leaving G2211. what need to do for this scenario? can any one help this scenario to resolve the issues?
 
Gokul Sagadevan said:
My claim coded with CPT's G0439, 99214-25, G2211 and 69209. As per 2025 revised guidelines per MLN Matters Number: MM13473, the add on code G2211 is payable even if you report the base code with modifier 25 only when the service or other procedure requiring the reporting of modifier 25 is an allowed Part B services. (https://www.cms.gov/files/document/r13199otn.pdf-0#page=9). In mentioned link G0439 was available but 69209 was not in the list of attachment 1. Now can we remove G2211 or just leaving G2211. what need to do for this scenario? can any one help this scenario to resolve the issues?
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In your scenario, 99213 and 69209 bundle and may be overridden with -25 when appropriate. Since -25 is coded for a reason other than the specified -25 exceptions, G2211 is not payable per Medicare.
 
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