G2211 Code

Medical services are compensated by insurance companies and other medical coverage systems (like Medicaid, Medicare) by a system of codes that are submitted to those groups from the offices and systems providing the care for the patient. These codes, and the services to which they are linked, are determined by a U.S. federal system called the Center for Medicaid and Medicare Services (CMS).

Certain codes are designated for use in very specific situations. One of these codes,* G2211*, is used specifically for care that is rendered by Primary Care providers (such as family practice providers, pediatricians, and internists). This code indicates that the primary care provider has not just provided a service on a given day, but that he/she has committed to caring for this patient in the context of the patient’s “medical home” or over a long-term relationship.

This code was created by CMS to indicate the nature of the complexity and resources necessary to be in a position to provide truly comprehensive care for a patient. The code *is not* related to a specific diagnosis or visit type. Instead, it refers to the long-term, dedicated practitioner-patient relationship. Unlike Urgent Care clinics and emergency rooms, Primary Care offices such Advocare Delaware Pediatrics are a patient’s “medical home.” Our providers and staff take tremendous pride in offering comprehensive, relationship-based care to your family.

With this in mind, you will note that the G2211 code will be added to our filing with your insurer for all visits for which it is defined as applicable.

It is unfortunate, but some insurance companies have decided not to recognize this code and will not reimburse Primary Care offices for the status of providing a patient’s “medical home,” and the work and resources expended to care for our patients. Some carriers will deny the code completely. Others will pass the fee onto the insured family. We are not happy with this situation and feel that the insurer’s refusal to recognize this code is unfair to you, and to our efforts to serve you and your family. We will continue to code for services provided, as defined by the CMS. We strongly suggest that you contact your insurer directly if they fail to cover this invaluable service.

We at Advocare Delaware Pediatrics feel deeply honored every day to be in a position to provide the children in our community with the highest quality of care possible. Maintaining our mission requires that we use the appropriate coding, in order to continue to support our efforts in serving your family.