Wiki Has anyone had success with CPT G2211?

[Faith07]

We began billing this code, however we found that only Medicare and Medicare Advantage plans will cover it. All commercial payers indicate this code is not payable. Blue Shield was paying this code but came out with a new policy in April 2025 that they will no longer pay. Has anyone had success or any information that this code will be payable by commercial carriers. It's a little surprising for the payers that follow Medicare guidelines.

 

[Cheezum51]

I have seen anecdotal reports of some commercial mayors reimbursing for this code. However, there doesn't seem to be any consistency in who pays nor how much they do pay. Sorry I can't give you any specific info. I would continue to file the code to see if you do find a carrier that does pay it.

 

[Faith07]

Thank you for your help, I don't believe any of the payers will be reimbursing. We have pulled all of the policies and billed all payors and they are only indicating they will pay for Medicare Advantage plans.

 

[cwainwright@ricelandhealthcare.com]

I presume you are billing the normal e/m code as well? Are you billing it with any modifiers?

 

[Faith07]

No we are not billing with modifier 25, just a normal E/M no modifiers.

 

[Pam Warren]

Medicare Advantage is supposed to follow CMS guidelines and accept the G code, but our experience has been variable.
G (for Government) codes are typically reserved for Medicare (and sometimes Medicaid) use. Commercial payers can choose to adopt them, if a CPT code isn't specific enough, but not always.

 

[greendm]

Medicare Advantage is supposed to follow CMS guidelines and accept the G code, but our experience has been variable.
G (for Government) codes are typically reserved for Medicare (and sometimes Medicaid) use. Commercial payers can choose to adopt them, if a CPT code isn't specific enough, but not always.

I have a question about medicare advantage plans and G2211. BC Mcare and UHC mcare require a 25 modifier with 51798, but not with medicare. Can G2211 be billed with E&M in either of these circumstances? Thank you!

 

[Pam Warren]

I have a question about medicare advantage plans and G2211. BC Mcare and UHC mcare require a 25 modifier with 51798, but not with medicare. Can G2211 be billed with E&M in either of these circumstances? Thank you!

51798 is a technical-only code (no physician work RVUs), so you shouldn't have any difficulty getting paid for the G2211 with your E&M service. In fact, I'm surprised you need a -25 for any payer, but they all make up their own rules, don't they?!

 

[rachaelwilleford]

I have a question about medicare advantage plans and G2211. BC Mcare and UHC mcare require a 25 modifier with 51798, but not with medicare. Can G2211 be billed with E&M in either of these circumstances? Thank you!

Medicare allows reimbursement for G2211 when billed with a E/M appended with modifier 25 when accompanied by certain preventative and Part B services. Here's their MLN article.

 

[ksuper@lifespark.com]

Yes! We are seeing reimbursement for many payers (original Medicare, Medicare Advantage). You can add on to any of your complex established visits and no modifier is needed unless you are adding an annual wellness visit, in which case you would use -25.