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What Is G2211?

G2211 is an HCPCS add-on code, introduced in the 2024 Physician Fee Schedule Final Rule. Providers can bill this code when they incorporate longitudinal, comprehensive primary care into an E&M visit for a Medicare patient.

In the 2025 PFS Final Rule, CMS expanded their support for G2211, specifying that the code can be billed during Medicare Annual Wellness Visits. Because of this expansion, G2211 has become a popular topic of discussion among providers and clinical staff. Here’s what you need to know when deciding whether to bill G2211. 

The G2211 code for practices

A provider can bill G2211 when they spend time during an E&M visit building an ongoing relationship with the patient. They must serve or intend to serve as the patient’s focal point of care and help them with care for a serious or complex condition.

CMS describes the code as, “G2211 captures the inherent complexity of the visit that's derived from the longitudinal nature of the practitioner and patient relationship.”

No specific diagnosis is required for providers to bill G2211. However, CMS states that the provider must take responsibility for the patient consistently over time. Because of this requirement, G2211 fits into CMS’s current emphasis on patients forming long-term, meaningful relationships with their providers. 

For example, a patient may visit their PCP because they’re feeling sick. If the provider treats them for influenza, while also checking on the patient’s diabetes and how they’re managing it, the provider could bill G2211. However, if a patient visits a provider they’ve never seen before, receives care for the flu, and then leaves, G2211 would not be appropriate. 

G2211 reimbursement

The average national reimbursement rate for G2211 is around $16. Individual reimbursement rates vary by state. G2211 can be billed alongside CPT Codes 99202-99205 and 99211-99215.

As of 2025, providers can also bill G2211 with Medicare Annual Wellness Visits (G0438 and G0439). For G2211 to be reimbursed, medical records should show providers giving patients care for a complex or serious condition, along with the care they gave during the AWV or E&M visit. 

Why G2211 is important

By expanding the instances when G2211 can be billed, CMS supports providers who give Medicare patients ongoing, personalized care. The code recognizes the work providers put into building relationships with patients and designing long-term care plans.

When using code G2211, providers can protect or even increase their Medicare reimbursements, while continuing to build relationships with their patients. 

Connection with APCM

Some providers and clinical staff have questioned whether G2211 overlaps with Advanced Primary Care Management, another new program from CMS. Although the two have similarities, G2211 is an add-on code for appointments with a provider, while APCM is a care management program offered between regular appointments. 

Both APCM and G2211 ask that providers focus on ongoing relationships and building care plans to manage health conditions. However, G2211 is an add-on code for E&M visits. It should only be used when the patient has an appointment with their provider, and the provider uses that appointment as an opportunity to offer ongoing care.

By contrast, Advanced Primary Care Management takes place between patients’ appointments. It is overseen by the provider but can be performed by care managers or nurses under general supervision.

Differences in APCM and G2211 capabilities

APCM also requires many capabilities that G2211 does not. For example, APCM requires practices to have: 

• A 24/7 care line
• Digital communication options, like email, text, and a patient portal
• Alternate care delivery options, like home visits or expanded hours
• Transitional care when patients leave the hospital or ER
• In-home and community-based care

And more. G2211 doesn’t have all of these requirements, only a requirement that the provider offer care for complex or serious conditions during E&M visits.

CMS explicitly states that “We do not believe HCPCS code G2211 necessarily would be duplicative of care management services since the concept of inherent complexity better recognizes the professional work that occurs during the visit, while the care management codes generally recognize services that happen outside of the visit.”

This is good news for practices, since it means they can incorporate G2211 into in-office visits, while also offering APCM or other care management programs outside of office visits.  

Changes to G2211 in 2025

Providers were able to begin billing G2211 in 2024, but CMS expanded the instances where the code can be used in the 2025 Physician Fee Schedule Final Rule. 

G2211 can now be added to Annual Wellness Visits (G0438 and G0439), as well as to the previously-approved codes 99202-99205 and 99211-99215. This important change makes Annual Wellness Visits and their associated preventive care more appealing to patients. 

Instead of coming in for only an AWV, patients can complete their Health Risk Assessment, speak with their provider about the results, and receive their provider’s advice on managing their ongoing conditions. The ability to discuss conditions and build a long-term relationship with their provider adds value to an AWV and makes patients more likely to complete one.

The ability to bill G2211 also increases the value of AWVs for practices. When G0211 is included, the average reimbursement for G0438 rises from $173 to $189, a 9% increase. The total average reimbursement for G0439 would increase from $117 to $133, a 14% increase. 

Incorporating G2211 gives providers the opportunity to provide more effective care during AWVs, while receiving reimbursement for their efforts.

Understanding and incorporating the G2211 code

G2211 is one of CMS’s many efforts to reimburse providers for the work they put into establishing long-term, ongoing relationships with patients and helping them manage their conditions. However, it shouldn’t be confused with care management programs, like Advanced Primary Care Management or Chronic Care Management. 

G2211 is a code providers can bill for the care they provide during E&M appointments. Care management programs, on the other hand, encourage care managers and nurses to offer care to patients in between visits, under the provider’s general supervision.

G2211 also has the potential to be billed with specific types of Medicare visits, like Medicare Annual Wellness Visits. To learn more about AWVs and how to administer them, check out our Annual Wellness Visits page.