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.

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[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

 

[Wheatbread]

Just wanted to follow up on this as my system sent us an email about this code. Sounds like it can be added for any follow up regardless of insurance as long as it’s a long term relationship? Seems pretty straightforward.

 

[Merovinge]

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

Interestingly my partner is a surgeon and is still billing this code for a significant part of her outpatient practice. I guess the type of surgeon may matter, but many surgeons are following patients longitudinally rather than seeing pt's on a 1-off situation.

and yes @Wheatbread it's very straightforward for 95% of psychiatric cases which are ongoing chronic disease management care. A you-don't-have-ADHD-stop-watching-TicToc consult might not cut it, but almost every psychiatrist should be jamming this billing code on almost every outpatient encounter.

 

[splik]

Interestingly my partner is a surgeon and is still billing this code for a significant part of her outpatient practice. I guess the type of surgeon may matter, but many surgeons are following patients longitudinally rather than seeing pt's on a 1-off situation.

and yes @Wheatbread it's very straightforward for 95% of psychiatric cases which are ongoing chronic disease management care. A you-don't-have-ADHD-stop-watching-TicToc consult might not cut it, but almost every psychiatrist should be jamming this billing code on almost every outpatient encounter.

Only medicare covers it (including some medicare advantage plans). Though some RVU based jobs expect people to add it on and give you the RVUs even though they don't get paid for it.

 

[Stagg737]

Just wanted to follow up on this as my system sent us an email about this code. Sounds like it can be added for any follow up regardless of insurance as long as it’s a long term relationship? Seems pretty straightforward.

You can try, but our academic center has said to just use it for Medicare and Medicare advantage plans. When it first came out we were using it for every plan, but apparently private insurance never reimbursed it for us and Medicaid here stopped reimbursing it a few months ago.

This is probably going to end up being a similar situation as 90785 where it was being used every time someone used a translator and got amended to limit its use. Maybe it won't since it was meant to offset lowering the conversion factor, but I doubt that will really stop them from limiting it's use going forward.

and yes @Wheatbread it's very straightforward for 95% of psychiatric cases which are ongoing chronic disease management care. A you-don't-have-ADHD-stop-watching-TicToc consult might not cut it, but almost every psychiatrist should be jamming this billing code on almost every outpatient encounter.

We've been told you can't use it for an initial appointment because it's not ongoing care. It can certianly add up if you see a lot of medicare patients, but otherwise it's probably not going to add too much if you don't.