The G2212 CPT Code Description refers to a Medicare-specific add-on code used for billing prolonged outpatient evaluation and management services. It applies when a physician or qualified healthcare professional provides care that exceeds the maximum required time of a primary CPT code, such as 99205, 99215, or 99483. This code is billed in 15-minute increments, whether or not the professional has direct contact with the patient.
In 2025, understanding the G2212 CPT code description is vital for clinics and providers who base their billing on total time spent during a patient’s visit. The time must go beyond the highest threshold listed in the CPT guidelines, not just the minimum.
Why G2212 Was Introduced and Its Role
The G2212 CPT code description exists to clarify and standardize prolonged care billing for Medicare and some Medicare Advantage plans. It was created as an alternative to CPT code 99417, which is still used by many commercial insurers. However, Medicare rejected 99417 because its time calculation starts from the minimum required time, which could lead to overbilling.
G2212 ensures that only those providers who truly exceed the maximum listed time for a service are compensated for extra time. This approach improves billing accuracy and supports patient-centered care that often extends beyond scheduled visit durations.
| Field | Details |
|---|---|
| Code | G2212 |
| Used With | 99205, 99215, 99483 |
| Time Requirement | 15 minutes beyond maximum of base CPT |
| Contact Type | Direct or indirect (same day) |
| Excludes | 99358, 99359, 99415, 99416 |
| Documentation Need | Total time, activity summary, CPT time selection justification |
| Payer Type | Medicare, some Medicare Advantage plans |
| Year Active | 2025 (Still in active billing use since 2021) |
Primary CPT Codes That Accept G2212
The G2212 CPT code description only allows billing in conjunction with specific primary codes. These are:
- 99205 – New patient, high-level E/M (60–74 minutes)
- 99215 – Established patient, high-level E/M (40–54 minutes)
- 99483 – E/M for patients with cognitive impairment (up to 75 minutes)
Once a provider surpasses the upper limit of these time ranges, they may begin billing G2212 in 15-minute increments.
Read more: Duolingo code
Time Calculation Example Using G2212
Understanding time calculation is crucial in applying the G2212 CPT code description correctly. Let’s look at a few examples:
| Primary Code | Base Max Time | Time Spent | G2212 Units Billed |
|---|---|---|---|
| 99215 | 54 minutes | 70 minutes | 1 |
| 99205 | 74 minutes | 90 minutes | 1 |
| 99483 | 75 minutes | 105 minutes | 2 |
These examples show that G2212 is billed after the base code’s highest limit, not the average or minimum. Each 15-minute block must be complete, meaning 1–14 extra minutes would not qualify.
Documentation Requirements for G2212
To meet the rules outlined in the G2212 CPT code description, documentation must clearly reflect:
- The total time spent with or on behalf of the patient
- That the base CPT code was selected based on time, not medical decision-making
- A breakdown or summary that supports the additional 15-minute unit(s)
Providers may include time spent on reviewing records, coordinating care, or counseling patients—even if not all of this happens face-to-face.
Why Not Use CPT 99417 Instead?
CPT 99417 may look similar, but Medicare does not recognize it. That’s why the G2212 CPT code description was created. It addresses a gap in the billing process for prolonged E/M services.
The key difference is that G2212 requires time to exceed the maximum, while 99417 starts from the minimum. This distinction reduces the chance of duplicate billing or overuse of add-on codes.
In summary, commercial payers might still allow 99417, but Medicare and related plans prefer G2212.
G2212 vs. Other Prolonged Service Codes
Providers must avoid confusion when choosing the correct prolonged care code. The G2212 CPT code description clearly excludes billing on the same day as other similar codes like:
- 99358 – Prolonged non-face-to-face before/after care
- 99359 – Each additional 30 minutes of such care
- 99415 – Staff face-to-face prolonged service
- 99416 – Additional 15 minutes for above
Trying to bill these together with G2212 for the same visit date can lead to claim denials.
Medicare and Medicare Advantage Plan Policies
Medicare universally accepts the G2212 CPT code description, but Medicare Advantage plans vary. Some accept both G2212 and 99417, while others restrict usage to G2212 only.
Before billing, providers should always verify payer-specific policies. It’s also smart to check if modifiers or unique time tracking documentation is required.
Common Use Cases for G2212
Providers typically use G2212 when a patient:
- Presents with complex, chronic conditions
- Requires detailed counseling or education
- Needs care coordination with specialists
- Involves end-of-life planning
- Has cognitive or behavioral health needs requiring longer visits
Such cases naturally extend beyond regular E/M visit durations. The G2212 CPT code description helps ensure providers receive fair reimbursement for these time-intensive visits.
Short Description and System Codes
The official short description of G2212 is “Prolong outpt/office vis”. Here are the associated system identifiers:
| Field | Code |
|---|---|
| HCPCS Action Effective Date | January 1, 2023 |
| HCPCS Code Added Date | January 1, 2021 |
| HCPCS Type of Service Code | 1 – Medical Care |
| HCPCS Pricing Indicator Code | 11 – National RVUs used |
| Anesthesia Base Unit Quantity | 0 |
| HCPCS Coverage Code | C – Carrier judgment |
These data points confirm that G2212 is nationally priced and evaluated under RVU methodology.
Read more: Promo code for crunch fitness
Frequently Asked Questions
What does G2212 CPT code description cover?
It covers each extra 15 minutes spent by a physician or qualified healthcare professional when E/M service time exceeds the maximum limit of the primary CPT code.
Can G2212 be billed without face-to-face time?
Yes, the code includes both direct and indirect patient care activities as long as they occur on the same calendar date.
Can G2212 be used with 99213 or 99214?
No, only codes 99205, 99215, and 99483 qualify for the G2212 add-on.
Is partial time (e.g., 10 extra minutes) billable with G2212?
No. The time must exceed the threshold by a full 15 minutes to bill even one unit of G2212.
Final Thoughts
In 2025, the G2212 CPT code description serves as a trusted solution for billing prolonged evaluation and management services. It fills a specific gap left by CPT 99417, ensuring that Medicare reimburses providers fairly for extended care efforts.
Clinics, hospitals, and private practices must use this code with precision. It supports patient care when needs are complex, and visits extend beyond the norm. At the same time, it keeps billing practices consistent and aligned with national standards.
If you’re a provider working with Medicare beneficiaries, mastering the use of G2212 is essential. It ensures that the extra care and time you invest do not go uncompensated, all while staying compliant with CMS guidelines.
Let me know if you want a version tailored for commercial payers or a comparison template between G2212 and 99417!