Why it matters: Family physicians expressed appreciation of the implementation of the G2211 Medicare add-on code that began on Jan. 1. The code, which more appropriately values the complex, continuous services family physicians provide, is a direct investment in evidence-based, whole-person primary care. It offers payment for ongoing holistic care such as modifying medication doses, providing referrals to and coordinating with specialists, and coordinating care across a continuum of settings.
However, we have work ahead of us to ensure that family physicians experience the full benefits of this code as intended—specifically, allowing payment for G2211 when an office or outpatient evaluation and management (E/M) visit is reported with modifier 25.
When a separate E/M service is performed in a visit, modifier 25 is attached to the coding of the visit. For example, addressing a complaint of sinus congestion during an annual wellness visit would be a separate, distinct E/M service.
Unfortunately, G2211 is not payable when the accompanying E/M visit is reported with payment modifier 25. This means that when a physician provides comprehensive care and services to address all of a patient’s needs in a single visit—for example, providing a vaccine while a patient is visiting for a different concern—they are unable to receive the additional resources G2211 offers for the additional complexity and time it takes to be the patient’s ongoing focal point of care.
What we’re working on
- The AAFP is sharing information with CMS about how the modifier 25 policy often prevents family physicians from billing G2211, which runs counter to the goal of supporting comprehensive, longitudinal care in a single visit.
- The AAFP urged CMS to allow payment for G2211 when billed alongside an E/M visit in the 2025 Medicare physician fee schedule when modifier 25 is attached.
- The AAFP has consistently and repeatedly supported G2211’s implementation and intended goals but raised concerns that the modifier 25 policy would negatively affect family physicians. We urged CMS to allow G2211 payment for an E/M visit billed with modifier 25 or, at minimum, when modifier 25 is used to bill an E/M visit alongside a Medicare annual wellness visit.
- We’ve also joined a letter with American College of Physicians and the American Academy of Home Care Medicine in support of G2211 resources being available for E/M visits provided in home and residence settings.