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UnitedHealthcare’s recent policy change regarding code G2211 impacts oncologist reimbursement for certain evaluation and management services. This development highlights the evolving landscape of medical billing and the importance of staying informed about payer policies.
Key Points:
- UnitedHealthcare will no longer separately reimburse code G2211 for commercial plans starting September 1, 2024.
- G2211 is an add-on code for E/M services, reflecting a provider’s role as the “continuing focal point” for complex or serious conditions.
- The policy change affects UHC commercial plans but not Medicare Advantage programs.
- Proper documentation supporting longitudinal relationships and complex condition management remains crucial for justified G2211 claims.
- CMS may allow G2211 payment with some modifier 25 E/M services in the 2025 Medicare Physician Fee Schedule Final Rule.
- Oncologists should monitor payer policies and potential Medicare updates regarding G2211 usage.
“From the beginning, it was always seen as a Medicare add-on code, and I assumed that commercial payers probably would not pay for it separately.”
– Dreama Sloan-Kelly, MD, CCS, CPC, CEO of Dr. Sloan-Kelly Consulting
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