G2211 is one of the most eagerly-awaited codes of 2024, allowing your practice to collect an extra $16 from Medicare when you perform an E/M service for a patient whose ongoing care your doctor is providing. Practices that are counting on that extra pay to come through, however, should plan to wait just a bit longer to collect.
Read on to discover what CMS says about collecting from Medicare for G2211.
Implementation Date Delayed to Feb. 19
When CMS announced that it would start paying practices for add-on code G2211, the effective date was announced as January 1, 2024 — and yet, that date has come and gone, with most practices not yet seeing a dime for G2211 claims.
Here’s why: While Jan. 1 remains the effective date, the actual implementation date for G2211 is now February 19, 2024, CMS said in Transmittal 12461, issued on January 18.
What happens if you bill G2211 now? The answer depends on your Medicare Administrative Contractor (MAC). While some MACs are holding G2211 claims with dates of service of Jan. 1 or after, with the apparent intention of processing them after their computer systems are updated so they can process them, others are simply denying them.
What Your Practice Should Do With G2211 Claims Now
How you handle your claims for G2211 now will depend on whether you’ve already sent them to your payer or not, and whether you’ve seen denials.
If you’ve submitted E/M claims with G2211 as your add-on code and you’ve gotten denials, keep track of which claims fall into this category and set them aside for right now. Once the calendar turns to February 19, resubmit one (not all) of these claims to the payer to see if it gets processed. If the claim is then paid, that likely means your payer is now set up to reimburse G2211 and you can resubmit the remaining denied claims in this category.
If that claim is denied again, contact the MAC and find out why. It’s possible that your payer is still not ready to process them, or it could be that you’ve made a mistake that you need to rectify before you can collect.
For practices that have submitted claims for G2211 and haven’t heard back at all — via denials or payments — you may need to sit tight. Your payer may be holding these claims until its systems are ready to process them. If you still don’t hear anything after the Feb. 19 implementation date, then it may be a good idea to reach out to your MAC for an explanation.
If you haven’t yet submitted your G2211 claims, it may be a good idea to hold off. Keep track of which claims include G2211 on them for dates of service Jan. 1 and after, and don’t submit them until after Feb. 19.
Collecting for G2211 means knowing the ropes, and they are complicated. Expert Dreama Sloan-Kelly, MD, CCS, CPC, can help you untangle the regulations. During her online training, G2211: Collect $16 More Per E/M Visit in 2024 With Key Tips, she’ll provide you with actionable tips that can help you code and bill properly to collect maximum income this year. Register today!
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