HCPCS G2211 Medicare rate and RVUs

Contracted rate: % of Medicare Copy link

Commercial contracts are often written as a percentage of Medicare ("115% of Medicare"). Enter yours to see what it means for G2211. A contract benchmarked to the fee schedule applies it to your locality's allowed amount, not the $17.37 national baseline; the calculator finds that amount from your service ZIP.

See how to find your contract's actual percentage.

Rates by locality Copy link

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Look up your exact locality →

Q4 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

HCPCS G2211 has a work RVU of 0.33, a non-facility practice expense RVU of 0.17, a facility practice expense RVU of 0.08 and a malpractice RVU of 0.02—for total non-facility RVUs of 0.52 and total facility RVUs of 0.43 in the Q4 2026 release.

The formula is: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, never as zero.

Who’s billing it Copy link

Global period: what G2211's fee already covers Copy link

This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.

Billing policy Copy link

These billing-policy indicators explain how G2211 is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National Office (non-facility) amounts for the modifiers this code's indicators support. These are single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Not payable with G2211: -26/TC (professional/technical split); -50 (bilateral procedure); -62 (co-surgeons, each); -66 (team surgery).

Each amount applies a standard MPFS percentage (assistant surgeon 16%, non-physician assistant at surgery 13.6%, co-surgeon 62.5%, bilateral 150%) to the national Office (non-facility) amount above. CMS doesn't publish these as a column; Localis derives them, so check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator allows it only when documentation of medical necessity is submitted. Without that documentation, an unpaid claim is not an underpayment.

CMS RVU26D · October 1 – December 31, 2026 · revision 2 See file rows

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for G2211 →

Payment review for G2211 Copy link

G2211 is a separate line, not a percentage built into the office visit. Check the base visit and the add-on separately, using the rules and fee-schedule release in effect on the date of service.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS FAQs about E/M visit complexity add-on HCPCS code G2211; CMS MLN Matters MM13473: how to use G2211.

Rate history by release Copy link

National Office (non-facility) amount for G2211 across quarterly releases. +8.3% increase since Q1 2024 · peak $17.37 in Q1 2026

Why G2211's rate changed Copy link

National baseline (GPCI 1.000) · Office (non-facility) · Before sequestration

G2211's national amount rose $1.33 (+8.3%), from $16.04 in Q1 2024 (from Jan 1) to $17.37 in Q4 2026. Changes to the conversion factor, which CMS sets for every code, added $0.32. CMS revaluing G2211 itself added $1.01: +$1.01 from practice-expense RVUs. The most recent change came in Q1 2026: +$1.84 (+11.8%), with +$1.33 from practice-expense RVUs and +$0.51 from the conversion factor.

CMS doesn't publish this split; we derive it from each release's RVUs and conversion factor. We apply the new conversion factor to the earlier RVUs first, then price each RVU change at the new conversion factor. Another order would move a few cents between columns, but every total stays the same.

Code and billing changes Copy link

The most relevant verified changes to this code and related Medicare billing policy.

Planned Full interactive timeline, two-date comparison, and an exportable citation packet.

View all 3 changes, review scope, and source evidence

Who bills G2211 to Medicare

Observed CY2024 Medicare fee-for-service billing, by the rendering clinician's CMS specialty. Each share is that specialty's slice of all observed services for this code that year.

Setting split that year: 90% Office (non-facility) · 10% facility. CMS publishes only this facility vs non-facility split, never the exact place of service. The Office (non-facility) figure does not identify urgent care or any other specific setting.

CY2024 Medicare fee-for-service only, from the CMS Physician & Other Practitioners dataset, which suppresses rows under 11 beneficiaries. We omit specialty groups with fewer than 30 observed clinicians, so the shares can fall short of 100%. Specialty and practice-type pages linked elsewhere on this page are curated code lists, not utilization claims.

How G2211 compares with other codes Copy link

Against every code with a national PFS amount in Q4 2026 · National baseline · Before sequestration

+20.9% Office over facility

G2211's Office amount is $3.01 more than its facility amount, because a facility bills its own overhead separately. Of the 7,745 codes priced in both settings, 2,167 have a higher Office amount. G2211's gap is smaller than 93% of theirs; the median gap is +78.1%.

41.3% Highest vs. lowest locality

G2211's Office amount is 41.3% higher in its highest-paid payment locality than in its lowest. That spread is narrower than 63% of the 7,716 codes compared; the median spread is 43.6%. How much a code's amount varies by locality depends on its mix of work, practice-expense and malpractice RVUs, since each has its own GPCI.

These comparisons cover every code with a national Physician Fee Schedule amount: status A, R or T, with no blank RVUs. The locality comparison leaves out codes with an OPPS cap, because the cap, not the GPCIs, can set their amount in some localities.

Related codes Copy link

Codes near G2211 in the Medicare G-code services group, with their national Q4 2026 amounts at GPCI 1.000. A dash means the release publishes no payable PFS amount in that setting.

Localis groups these codes for payment research. The grouping isn't the AMA's code families.