On January 8, 2025, Medicare National Government Services (NGS), released a notice alerting Part B providers, in Jurisdiction JK and Jurisdiction J6, of improper denials for HCPCS code G2211.

National correct coding initiative (CCI) editing for HCPCS G2211 code was updated on 12/5/2024 to require HCPCS G0463 as the primary code for G2211 add-on code. This has resulted in denials of claims for the add-code G2211 when billed with current procedural terminology (CPT) 99202-99205 and 99211-99215. This error has impacted claims for dates of service 1/1/2024-9/30/2024 when processed on or after 12/5/2024.

National Government Services (NGS) is fully aware of the issue and has reached out to Centers for Medicare & Medicaid Services for instructions. The NGS Provider Call Center has no additional information on these claim denials and calls to the call center on this topic will yield no additional information.

No provider action is indicated by NGS, at this time.  NGS will post additional information on these claims when available.

HCPCS G2211, add-on code reported with new and established patient office/outpatient evaluation and management services, to indicate that additional work is involved in managing high-complexity patients within a standard E/M visit

HCPCS G0463, used to bill for a hospital outpatient clinic visit or assessment and management of patient in a hospital outpatient setting.

 Source: NGS Medicare Notice, 1/8/25