G2211 A Long-Awaited Payment for Primary and Longitudinal Care

Author: Keisha Wilson CCS, CPC, CRC, CPB, CPMA, AAPC Approved Instructor

So, We Are Finally Here

The wait is finally over! After years of anticipation and advocacy, (Healthcare Common Procedure Coding System) HCPCS code G2211 is set to be implemented on January 1, 2024. Does anyone else remember the stress we were under at the end of 2020 trying to educate physicians, coders, billers, and IT departments on the rollout of these codes for January 1, 2021? Then it never happened!!! Nonetheless, we are finally here again a few years later, and this time to stay.

This new code will provide a separate add-on payment for primary care and longitudinal care visits (ongoing proactive healthcare appointments for patients), recognizing the significant cognitive load, responsibility, and accountability involved in managing a patient’s overall healthcare needs.  Later on in this article, we will dive more into “longitudinal care visits)

In the following sections, we will look at G2211, including its specific eligibility requirements, potential impact on the healthcare system, and resources available for clinicians and patients.

Implementing G2211

For primary care clinicians, who often serve as the continuing focal point for their patients’ healthcare services, G2211 represents a long-overdue recognition of their unique value. In addition to managing acute illnesses and injuries, these clinicians build strong, trusting relationships with their patients, which is essential for ensuring adherence to treatment plans and optimal health outcomes.

Implementing G2211 conveys that Medicare recognizes the importance of primary and longitudinal care. This much-needed payment will help ensure these essential services remain accessible and affordable for all patients. G2211 will be applied to outpatient and office visits as additional payment, identifying the inherent costs involved when physicians are part of ongoing care related to a patient’s single, serious, or complex condition.

G2211 – 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)

Longitudinal Care Visits

Longitudinal care visits are ongoing and proactive healthcare appointments focused on managing a patient’s health and well-being and ongoing relationships between the patient and their physicians. They differ from traditional episodic care, which typically addresses specific acute illnesses, serious or complex conditions or concerns.

Here are some key characteristics of longitudinal care visits:

Focus:

  • Preventative care: These visits focus on preventing future health problems and promoting healthy lifestyle choices. This includes activities like immunizations, screenings, and wellness counseling.
  • Chronic disease management: For patients with chronic conditions like diabetes, heart disease, or mental health disorders, longitudinal care visits are crucial for managing their symptoms and preventing complications.
  • Holistic approach: These visits consider all aspects of a patient’s life, including their physical, mental, social, and emotional well-being.
  • Continuity of care: Patients see the same healthcare provider over time, allowing for a strong and trusting relationship to develop. This continuity is essential for personalized care and effective management of complex conditions.

Frequency:

Longitudinal care visits occur more frequently than traditional episodic visits, typically ranging from every few months to annually, depending on the patient’s needs and health status.

Benefits:

  • Improved health outcomes: Longitudinal care has been shown to improve health outcomes for various chronic conditions.
  • Increased patient satisfaction: Patients appreciate the personalized attention and continuity of longitudinal care.
  • Reduced healthcare costs: By preventing complications and promoting healthy lifestyle choices, longitudinal care can ultimately reduce healthcare costs.

Examples of healthcare providers who might offer longitudinal care:

  • Primary care physicians
  • Family doctors
  • Internists
  • Pediatricians
  • Geriatricians
  • Nurse practitioners
  • Physician assistants

In summary, longitudinal care visits are essential to a comprehensive healthcare system. They offer numerous benefits for both patients and the healthcare system as a whole.

Visit Complexity

Per the 2024 Final Rule, 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 complex chronic condition. (Add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established).  This code may be used by primary care and certain other specialities who are addressing health needs with consistency and continuity over a long period of time.  CMS recently published an MLN matters article on November 21, 2023, which addressed the final rule and stated, “We finalized the rule that the O/O E/M visit complexity add-on code G2211 isn’t payable when you report the O/O E/M visit with payment modifier 25. For institutional claims, this applies to Method II Critical Access Hospitals on the same encounter for the type of bill 85X only.”

Telehealth

Additionally, CMS has permanently added code G2211 to the approved telehealth service list.  As of the most updated list revised on November 13, 2023, this code can also be used with audio-only interaction.

Chart Example for G2211

  • Example 1: In the context of primary care, HCPCS code G2211 could recognize the resources inherent in holistic, patient-centered care that integrates the treatment of illness or injury, management of acute and chronic health conditions, and coordination of specialty care in a collaborative relationship with the clinical care team.
  • Example 2: In the context of specialty care, HCPCS code G2211 could recognize the resources inherent in engaging the patient in a continuous and active collaborative plan of care related to an identified health condition the management of which requires the direction of a clinician with specialized clinical knowledge, skill and experience. Such collaborative care includes patient education, expectations and responsibilities, shared decision-making around therapeutic goals, and shared commitments to achieve those goals.

Summary

Overall, G2211 represents a significant step forward for primary and longitudinal care. Providers can expect a positive impact on their practice finances, clinical practice, and administrative processes. However, it’s important to stay informed about the latest regulations, eligibility and guidelines to ensure successful implementation and maximize the benefits of this code. With any new code, there is an increased risk followed by audits. Providers should ensure accurate documentation and coding to comply with the regulations.  I encourage all organizations to be proactive and start reviewing providers’ documentation within a few weeks or months of using the G2211.

To schedule training for your organization or private practice providers’ clinical and billing staff, email us today at info@kwadvancedconsulting.com or visit the website and fill out the “contact us” form.

Resources

https://public-inspection.federalregister.gov/2023-24184.pdf

2020-26815.pdf (federalregister.gov)

https://www.cms.gov/files/document/mm13272-edits-prevent-payment-g2211-office/outpatient-evaluation-and-management-visit-and-modifier.pdf

file:///C:/Users/16462/AppData/Local/Temp/25251c22-2b07-4a4a-a820-271f6190b40b_CY%202024%20PFS%20Final%20Rule%20List%20of%20Medicare%20Telehealth%20Services_V13Nov2023%20.zip.40b/CY%202024%20PFS%20Final%20Rule%20List%20of%20Medicare%20Telehealth%20Services_V13Nov2023.pdf

https://www.cms.gov/files/document/r11842cp.pdf

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule#:~:text=Beginning%20January%201%2C%202024%2C%20CMS,primary%20care%20and%20longitudinal%20care.

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