G2211

[Psych19]

Our billing consult for the large academic department I work for recently shared that there is a new code beginning in 2024, 'care continuity' G2211, that we can supposedly add to most if not nearly all follow up appointments, even if we're also adding 90833 as well. Basically, it seems like an add-on billing code meant to partially reimburse for the expense and labor of providing longitudinal care to patients with complex conditions. You can use it with an E&M code (i.e. 99213/4/5, but not with 90792). Our consultant said CMS expects this code will eventually be used with up to 90% of all E&Ms in some specialities. We're being encouraged to use it liberally. It's worth a token number of wRVUs (0.33), though that's a nontrivial amount of wRVUs if used with most patients.

Curious if anyone else has heard about this code or begun using it.

---

Members don't see this ad.

 

[splik]

It's a HCPCS code, rather than a CPT code. It is specific to medicare. It's basically a rob peter to pay paul thing. CMS cut the conversion factor again this yr, so this code allows for greater reimbursement of those complex cognitive specialties that spend more time with patients. The surgeons were against it. The APA supported its implementation, so psychiatrists were expected to use it. CMS estimated 38% of E&M visits would use it in 2024.

However, I don't think it was intended to be used with psychotherapy add on codes. CMS increased the RVUs for psychotherapy add on codes this yr (90833 is now worth 1.57 up from 1.5, 90836 is now with 1.99 up from 1.9, and 90838 is now worth 2.62 up from 2.5 and you can't use G2211 with modifier -25 (i.e. if you're providing other services). That said, I've not seen anything saying you can't so you might as well try and see what happens.

of course, you should only use it for pts you provide longitudinal care to with complex conditions. Adjustment disorders etc probably wouldn't cut it.

ETA: I meant modifier 25 not 95. G2211 can be used with telehealth

 

[Psych19]

This is helpful background. Wasn't aware about the wRVU increases for psychotherapy codes. Thanks for sharing.

you can't use G2211 with modifier -95 (i.e. if you're providing other services).

Where did you read this? Do you mean you can't use G2211 with modifier 25? I thought modifier 95 was to indicate telehealth. For a while I was confused about whether we're supposed to add modifier 25 to E&M codes when we also bill psychotherapy add-ons, but our consultant said modifier 25 is actually not needed, and thus we can also add G2211 if we want.

 

[tennisall]

Can we only bill G2211 for Medicare patients? Is there an analogous CPT code yet for non-Medicare?

 

[Psych19]

I think you can bill the code to any insurance you want, it's just a question of which if any insurances besides Medicare will pay. The ones I'm most interested to know about would be Medicare advantage plans, since so many Medicare patients actually have private advantage plans.

 

[claypigeon]

Our hospital system coder got back to me and said this will only be reimbursed for medicare/medicaid/advantage plans