Ann Intern Med
Medicare billing code meant for complex, chronic care sees slow uptake
Clinical takeaway: Slower-than-anticipated uptake of the new code may affect reimbursement assumptions and could continue to undervalue long-term care for complex and chronic disease patients.
A CMS billing change intended to better reflect the work of managing chronic conditions is not yet widely adopted. The G2211 add-on code, introduced in January 2024, was designed to account for previously uncompensated longitudinal, nonprocedural care.
These care activities include coordinating care across clinicans, adjusting treatment plans over time, managing multiple comorbidities, and maintaining a continuous patient–physician relationship.
CMS projected rapid uptake, estimating use in about 38% of eligible visits initially and more than 50% over time.
Across about 378 million outpatient visits, G2211 use actually rose from 5% of Medicare visits in early 2024 to about 27% by mid-2025, with similar uptake in Medicare Advantage and lower use among commercial payers (12%).
Use varies by specialty. It was highest in endocrinology (47%) and internal medicine (40%) and lowest in dermatology (20%). Several specialties, including primary care and hematology/oncology, used G2211 in about 30% to 40% of visits—far below CMS expectations of up to 90% for certain specialties.
Overall, clinicians are using G2211 for longitudinal care, but uptake may not reach levels assumed in current reimbursement models. Lower than expected use may reflect evolving billing rules, uncertainty about appropriate use, and variation in how often specialties provide longitudinal care.
“This may perpetuate the undervaluation of primary care, especially for complex patients,” the authors note.
Source: Smith JA, et al. Ann Intern Med. April 7, 2026. A Retrospective Study Evaluating the Utilization of G2211