Even though G2211 has only been payable since the beginning of the year, many practices have gotten accustomed to the additional $16.05 in G2211 reimbursement with certain E/M services. Unfortunately, one payer wants to limit practices from collecting for this service in some circumstances.
Read on to get the lowdown on how a new decision by UnitedHealthcare Commercial will change G2211 reimbursement.
UHC Will Halt G2211 Reimbursement for Commercial Plans Sept. 1
As part of its June 2024 updates, UHC quietly revealed that starting with dates of service on or after Sept. 1, 2024, its commercial plans will stop paying for G2211 (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)).
Instead, G2211 reimbursement will be “included in reimbursement for outpatient evaluation and management services.” Therefore, UHC added, “G2211 is not separately reimbursable.”
You Can Still Collect G2211 Reimbursement for Medicare Advantage
While many practices are bound to be disappointed about the end to G2211 reimbursement for commercial UHC plans, it’s important to know that Medicare Advantage plans under UnitedHealthcare will continue to pay for G2211.
The Reimbursement Halt Goes Beyond Employer-Based Coverage
Although UHC announced specifically that the change will only impact UnitedHealthcare Commercial policies, some programs that aren’t employer-sponsored may be affected by the change as well. For instance, some UHC plans that are offered through the health insurance marketplace (also known as Obamacare or Affordable Care Act exchange plans) may be affected as well. Always reach out to your payer representatives for clarification if you aren’t sure whether you can collect for G2211 under your UHC policies.
Check With Payer Reps About Medicaid
If your patients are covered under Medicaid managed care policies from UHC, check with your payer representative to determine whether they’re impacted by the change. In some states, they may be. But since Medicaid plans are not uniform nationally and are instead developed on a state-by-state basis, there may be discrepancies between states, even those that offer UHC plans for Medicaid managed care.
Brush up on G2211 Skills
If your practice is due to take a financial hit due to UHC’s G2211 reimbursement changes, it’s more important than ever to report the code accurately to payers that do accept it. This will help you boost your odds of reimbursement.
Always remember that every G2211 service must be part of a longitudinal period of care for a complex or chronic condition.
“Longitudinal” means the provider is continuing a relationship with the patient “that is expected to be of significant duration,” Medicare payers note. You can’t add G2211 to your E/M codes if you’re simply addressing a self-limiting condition during an isolated service.
It’s essential to know the ins and outs of what Medicare payers require before you report G2211. Get the lowdown with our exclusive FREE tool, G2211 Do’s and Don’ts to Collect Extra E/M Revenue. Download your free copy today!
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