2025 HCPCS code G2212
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Evaluation and Management - Prolonged Services Evaluation and Management Services Feed
This HCPCS code represents prolonged office or outpatient evaluation and management services exceeding the primary service's maximum time, billed in 15-minute increments.
Modifiers may apply based on the circumstances of the visit.Consult payer guidelines for appropriate modifier usage.
The medical necessity for the prolonged service must be clearly documented in the medical record.This includes rationale for the extended time spent, complexity of the case, and the medical reason why the visit extended beyond the typical time allotted for the selected E/M code.Supporting clinical documentation should link the time spent to a clearly documented medical need.
The physician or qualified healthcare professional is responsible for providing the prolonged evaluation and management service, including direct and indirect patient contact.
- Evaluation and Management Services
- HCPCS Level II, Evaluation and Management Services, Prolonged Services
In simple words: This code is for extra time a doctor spends with you during an office visit beyond the usual time.If the visit goes longer than normal, the doctor may use this code to bill for each extra 15 minutes.
HCPCS code G2212, "Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact," is reported separately in addition to CPT codes 99205, 99215, or 99483 for office or other outpatient evaluation and management services.This code is used when the primary service code (99205, 99215, or 99483) is selected based on total time and the visit extends beyond the maximum time allowed for that code.It should only be reported for time units of 15 minutes or more, and not on the same date of service as codes 99354, 99355, 99358, 99359, 99415, 99416.It is primarily used for Medicare claims unless otherwise specified by private payers.
Example 1: A new patient (99205) requires 80 minutes for a comprehensive history and physical exam.G2212 would be billed for the additional 15 minutes beyond the 60-74 minute range of 99205., An established patient (99215) consultation necessitates 75 minutes of time to review extensive test results and develop a comprehensive treatment plan. G2212 would be billed for the extra 15 minutes., A patient undergoing a complex cognitive assessment and care planning (99483) requires 75 minutes. G2212 is billed for the extra time exceeding the maximum time of a 60 minute visit for 99483.
Detailed documentation is required, including the time spent with the patient (face-to-face), time spent without direct patient contact, and the medical necessity for the prolonged visit.This should correlate with the total visit time supporting the use of the primary E/M code and the additional 15 minute increments of G2212.
** Always verify payer-specific guidelines for proper billing and reimbursement of G2212.This add-on code is not standalone, and requires a primary E/M code for accurate billing.
- Revenue Code: Revenue codes will vary depending on the payer and specific circumstances of the visit.Consult payer guidelines for appropriate revenue codes.
- RVU: RVUs for G2212 will vary depending on the geographic location and payer.Consult the appropriate fee schedule for current RVU values and reimbursement rates.
- Global Days: Not applicable. This is an add-on code used in conjunction with a primary E/M service.
- Payment Status: Active for Medicare, check payer guidelines for private insurance.
- Modifier TC rule: Not applicable. This code represents professional time.
- Fee Schedule: Fee schedules vary by payer and geographic location.Consult payer guidelines for historical fee schedule data.
- Specialties:All specialties that provide office/outpatient E/M services may utilize this code.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, other outpatient settings.