Urology Coding Q&A: Can G2211 be reported regardless of payer?

I have a question about G2211. As a pediatric urologist, am I allowed to report this code for patients who meet the criteria regardless of payer? Our practice has encouraged it to be used for adult urology patients who have Medicare but not in pediatric urology patients because they are not of Medicare age, and they believe this is a Medicare-specific code.

Jonathan Rubenstein, MD

We had addressed the definition and use of the Healthcare Common Procedure Coding System (HCPCS) code G2211 in previous Urology Times articles, including that of May 1, 2024.¹ As a quick reminder, the HCPCS G2211 add-on code descriptor is the following:

“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)”

Mark Painter

HCPCS codes can be used and accepted by any insurer. The insurer’s payment policies will determine whether it gets reimbursed. From our standpoint, it is reasonable to add this HCPCS code to any patient who meets the appropriate criteria, notwithstanding their insurance coverage. If a practice has determined in writing that there are insurers whose policies advised that they will not accept this code, it seems reasonable not to report that code to that insurer even when criteria are met.

REFERENCE

1. Rubenstein J, Painter M. Medicare’s G2211 and thoughts on how to best use it in urology. Urology Times. May 1, 2024. Accessed December 16, 2024. https://www.urologytimes.com/view/medicare-s-g2211-and-thoughts-on-how-to-best-use-it-in-urology

Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.

The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.