CPT 99211 code and billing history
Material coding, documentation, and Medicare billing changes, shown by effective date and backed by the source that established each change.
Investigated Jan 1, 2013–Aug 3, 2026
1 evidence limitationThe scoped review found the 2021, 2024, and 2025 G2211 billing transitions. Unlike office/outpatient levels 2 through 5, 99211 has no time or medical-decision-making level, so the family's 2021 time-selection event does not apply. No other material Medicare billing transition was located from 2013 through the review date.
Review scope and evidence limits
Scope: Material code-definition, staff-service requirements, and Medicare base/add-on billing transitions. Routine RVU and payment changes are shown separately in rate history. Broad temporary delivery waivers and editorial descriptor wording that did not establish a new reporting boundary are excluded.
Known limitation: A complete date-stamped public set of annual CPT guidance for 2013-2020 was not available from the authoritative web sources reviewed. The pre-2021 continuity conclusion is anchored by CMS's dated 2013 utilization evidence and its 2021 family guidance, rather than independently rechecked against every annual CPT edition.
- CMS 2013 Medicare physician utilization data fact sheet — Chart 1 discussion and Map 1 office-visit code list.
- CMS CY2021 office/outpatient E/M payment fact sheet — Pages 1-2, office/outpatient framework and G2211 sections.
- AMA office/outpatient E/M time-range guidance — Documenting and coding based on time, CPT code and time range table.
- CMS MLN Matters MM13272: G2211 payment and modifier 25 edits — Pages 1-2.
- CMS Change Request 13705: G2211 with listed preventive services — Pages 1-3 and Attachment 1.
Related Medicare add-on policy: G2211 Copy link
Changes to the separate G2211 add-on code that affect when it may be reported and paid with 99211.
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Effective Jan 1, 2025
G2211 gained a limited modifier 25 exception
Medicare began allowing G2211 with a qualifying office/outpatient E/M base code, 99202-99205 or 99211-99215, with modifier 25 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
- Before
- G2211 was denied whenever the associated office/outpatient E/M base visit carried modifier 25.
- After
- A limited exception permits G2211 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
Also affects 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS Change Request 13705: G2211 with listed preventive services — Pages 1-3 and Attachment 1.
- Corroborating: CMS CY2025 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2024
G2211 became separately payable
Medicare began paying G2211 in addition to qualifying office/outpatient E/M base visits, codes 99202-99205 and 99211-99215. At launch, G2211 was not payable when the base visit carried modifier 25.
- Before
- G2211 was reportable for qualifying visits but bundled, with no separate Medicare payment.
- After
- G2211 was separately payable for qualifying visits unless the associated base visit was reported with modifier 25.
Also affects 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS MLN Matters MM13272: G2211 payment and modifier 25 edits — Pages 1-2, Action Needed and Background.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2021
G2211 became reportable, but remained bundled
For qualifying longitudinal-care visits, G2211 could be reported with any new- or established-patient office/outpatient visit level, 99202-99205 or 99211-99215. Medicare assigned it bundled status, so it did not produce separate payment.
- Before
- No G2211 reporting relationship applied to these visits.
- After
- G2211 was reportable for qualifying longitudinal-care visits but bundled under the Medicare Physician Fee Schedule.
Also affects 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, G2211
View evidence (2 sources)
- Primary: CMS CY2021 office/outpatient E/M payment fact sheet — Page 2, Add-on Code for Visit Complexity.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
Looking for payment amounts instead? See the Medicare rate history for 99211.