G2211 and G0545 Codes: Unlock Reimbursement for Complex Patient Visits

Event Materials (Key Required)

Course Description

CMS created a new complexity code specifically that is effective from January 1, 2025. Initially, CMS created a new complexity code, G2211, in late 2020 but due to budget neutrality, activation of this code was delayed until January 1, 2024, and reimbursement began in February 2024. Little information was provided about this code in the beginning but as time goes by, more specific information has been forthcoming.

Considering the reimbursement cuts that are taking place with payors, including Medicare, the use of the complexity codes, when appropriate, can help alleviate a bit of the financial burden for your practice. It is crucial that you know and understand the specific use of these codes when it comes to revenue cycle management. This involves both the billing and reimbursement practices of the payors. It is important to be compliant when reporting these codes and understand the necessary documentation required.

Some commercial payors are recognizing and reimbursing the G2211. It is important that you know which of the plans will recognize this code. Do not miss reimbursement that is rightfully yours as per your contract. Will the payors follow suit with Medicare and recognize and reimburse for the new G0545? While this remains to be seen, only time will tell.

Learning Objectives

• Codes to report with complexity codes
• Definition of longitudinal care and how to document it
• Required documentation
• Why you should consider reporting these codes
• Are these codes to reported by primary care practitioners only
• Can non-physician practitioners report these codes
• Learn what Medicare has to say about these codes

Areas Covered in the Session

• Overview of Complexity Codes G2211
• Created 2021
• Implemented 2024
• Revised 2025
• Which Codes Can G2211 Be Billed With?
• G2211 – Code descriptor
• About the G2211
• What is Longitudinal Care?
• CMS Expectations
• G2211 and Medicare & Medicare Managed Care plans
• When to Use G2211 Code?
• Medicare Example
• When not to Use G2211 Code?
• What Information Can Support Continuity of Care?
• Example of A/P – Longitudinal Care
• How can a provider show that a new patient visit (99202-99205) is part of continuing care?
• Can a resident report G2211 under the primary care exemption?
• Are there any limits on the specialties that can report the code?
• Will CMS issue a list of conditions that meet the code’s serious or complex condition requirement?
• New for 2025 - G0545 Infectious Disease Complexity
• Created and Implanted in 2025
• G0545 - Use with IP Services Only
• Hospital Inpatient or Observation Care
• Initial – 99221-99223
• Subsequent – 99231-99233
• Discharge – 99238-99239
• Same Day Admission and Discharge – 99234-99236

Suggested Attendees

• Physicians and Non-Physician Practitioners
• Medical Coders
• Medical Billers
• Practice Managers
• Coding Managers
• Directors of Coding
• Denial Team
• Coding Compliance Team
• Auditors
• Revenue Cycle Team

About the Presenters

Jimmie is a Certified Professional Coder (CPC), Certified Medical Coder (CMC), Certified Medical Chart Auditor E/M (CMCA-E/M), Certified Medical Office Manager (CMOM), and Certified Medical Insurance Specialist (CMIS). Additionally, she has special expertise in the areas of human resource management and patient advocacy. Jimmie has conducted managed care contract analyses and negotiation and has extensive training and experience in diagnostic and procedural coding as well as effective reimbursement and collections techniques. She is well versed in Medicare issues, coding, and compliance.

Jimmie owns her own consulting company and has opened many physician practices in the greater Houston area. She is currently taking a break and pursuing her greatest passion which is teaching. Jimmie has traveled the country teaching physicians, medical practice administrators and staff about the latest issues in medical practice management and the business of management. Her background includes management of several multi-physician, multispecialty clinics, along with overseeing the revenue cycle operations of all Texas practices for a nationwide healthcare system.

Additional Information

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com 

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