Practice News

Medical offices get paid by “coding” what they do. These codes are designated by the Center for Medicaid and Medicare Services (CMS).

A new code – G2211 – has been created by CMS for primary care providers to indicate that they are following patients longitudinally and are committed to caring for the “whole patient” over time. This code is needed to account for the complexity and added resource costs of providing truly comprehensive primary care. This code is not related to a clinical condition. Instead, it refers to the long-term nature of the practitioner-patient relationship. Unlike urgent cares and emergency rooms, Pediatrics in Brevard (PIB) is recognized as a Patient Center Medical Home and takes pride in offering this type of care to your child(ren). As such, we will be adding this code to all permitted visits, which excludes annual physicals (well visits). Unfortunately, many insurance companies are not paying for all the services we provide, even if CMS says we need to document and code for what we do. Some carriers will completely deny payment. Others will pass the charge on to the patient. We are not happy with their position, and feel it is unfair both to us and to you. But, per our contracts with the insurance companies and complying with CMS, we must continue to code for services as instructed. If you receive a bill for this code, G2211, we will not be able to waive the charge. Instead, we ask that you follow up with your carrier directly for reimbursement. We take great pride in providing your child with the highest quality of care possible. Documenting and coding appropriately for the services we provide is necessary for us to continue to serve our families in this way.