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.