The list of health plans providing payment for Medicare’s new add-on “G” code continues to grow with Aetna as the latest insurer to cover G2211 for Medicare Advantage claims Aetna confirmed with Texas Medical Association coding experts that its Medicare Advantage claims platform was updated in March to allow payment for the code, used to document the coordination of care for patients with complex or serious conditions.
For now, the plan’s policy is only accessible through a physician’s Aetna portal.
Previously, three other national payers had confirmed coverage of G2211:
- Cigna (Medicare Advantage only);
- Humana (commercial and Medicare Advantage); and
- United Healthcare (commercial and Medicare Advantage).
The 2024 Medicare physician fee schedule allows physicians to list G2211 in addition to codes used in office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians also can use it for telehealth visits.
TMA continues to push for increased code guidance from federal officials as confusion over its use persists.
The Centers for Medicare & Medicaid Services (CMS) does not restrict G2211 to medical professionals based on specialties and recommends physicians bill the code if they are the continuing focal point for all needed services – like a primary care practitioner – or are giving ongoing care for a single, serious condition or a complex condition, like sickle cell disease or HIV.
TMA experts recommend physicians use G2211 when:
- They have assumed or intend to assume responsibility for the patient’s ongoing medical care; and
- They intend to apply the code to office and outpatient evaluation and management (E/M) services.
Physicians should not use G2211 when:
- The associated office visit’s E/M services is reported with modifier 25 appended; and
- Their visits with the patient are routine or time-limited. For example, a physician who sees a patient for an acute concern should not report G2211 if they have not also assumed responsibility for the patient’s ongoing medical care or do not plan to take responsibility for subsequent medical care.
- Additionally, TMA experts recommend practices update their electronic health record and billing systems to reflect the 2024 Medicare Physician Fee Schedule to verify G2211 is added. Practice management or billing and coding staff can help with this.
Physicians should also be aware that:
- They cannot append modifier 25 when billing for G2211;
- CMS has not defined "complex condition,” meaning physicians should create an internal policy on what complex condition means to them; and
- G2211 claims should not include templates and document patient-specific details.
For more information on billing and coding, visit TMA’s comprehensive Billing, Coding, and Reimbursement page
Last Updated On
March 27, 2024
Originally Published On
March 27, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469