APR 23, 2024
First Coast and Novitas Report Improper Billing of G2211
First Coast and Novitas, Medicare administrative contractors, both report that practices are experiencing denials for improperly billed Healthcare Common Procedure Coding System (HCPCS) code G2211.
The CPT add-on code known as the “complexity code” is being incorrectly billed with evaluation and management (E/M) visits that occur on the same day as minor procedures. Centers for Medicare & Medicare Services (CMS) guidelines state that G2211 should not be billed on the same date of service as an E/M code when modifier -25 is reported. Practices should not appeal these denials and refrain from submitting future claims that are not compliant with this CMS guidance.
CMS guidelines are provided in the Academy’s HCPCS code G2211 fact sheet at aao.org/G2211.