Office and Outpatient Evaluation and Management Visit Complexity Add-on Payment Code G2211
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Describes BCBS Tennessee's implementation of CMS's change to make G2211 separately payable for select Tennessee products and guidance to follow CMS billing rules; affects providers billing BlueAdvantage (PPO) SM and BlueCare Plus (HMO D-SNP) SM plans.
G2211 was made separately payable by assigning it an active status indicator effective Jan. 1, 2024.
Coverage Criteria for G2211
Plans implementing separate payment
Separate payment for G2211 will be followed for specific BCBS TN plans in accordance with CMS guidelines.
ALL of the following
Applies to plan
- BlueAdvantage (PPO) SM
- BlueCare Plus (HMO D-SNP) SM
- Follow CMS guidance on when and how to bill G2211; effective Jan. 1, 2024.
Plans not implementing change
Plans not adopting the CMS change for separate payment of G2211.
Coding and Effective Date
| G2211 | Office and Outpatient Evaluation and Management Visit Complexity Add-on Payment Code |
Billing Guidance and Provider Actions
Billing guidance — follow CMS rules; separate payment only for specified BCBS TN plans
Follow CMS guidance on when and how to bill G2211. BCBS TN implemented separate payment for G2211 for BlueAdvantage (PPO) SM and BlueCare Plus (HMO D‑SNP) SM plans only; Commercial and BlueCare Tennessee networks will not implement this change.
- G2211 assigned an “active” status indicator and made separately payable effective Jan. 1, 2024; follow CMS billing guidance for correct use.
- Separate payment implemented only for BlueAdvantage (PPO) SM and BlueCare Plus (HMO D‑SNP) SM; do not bill expecting separate payment for Commercial or BlueCare Tennessee networks.
Definitions
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