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CMS adds 98 codes to list of G2211-compatible preventive services

Effective Jan. 1, 2025, CMS revised its rules for visit complexity add-on code G2211. The new policy allows providers to report a primary office or other outpatient E/M code (99202-99215) with modifier 25 when the E/M visit is reported in conjunction with a covered preventive service.
 
However, when CMS released a list of 63 preventive service codes that could be reported under those circumstances in CMS 100-20, Change Request 13705, people discovered several services were missing. For example, Mary Beth Turner, MBA, practice administrator for Tri Valley Primary Care, noticed that codes G0008 (Admin influenza virus vac) and G0009 (Admin pneumococcal vaccine) were not on the list.
 
CMS this week updated the change request to add an additional 98 codes, for a total of 152 codes that can be reported when a practice also submits an office/other outpatient service with modifier 25 and the complexity add-on code. In addition, the agency removed nine codes, including colorectal cancer screening codes G0106 and G0120, which were deleted effective Jan. 1, 2025, and behavioral health assessment and intervention codes 96156-96158 and 96164-96168, which are not preventive services.
 
The change request does not include instructions on how MACs should handle claims that were denied because they included a covered preventive service that was not on the list, or what to do about claims reported with the behavioral health codes that should not have been on the list. Part B News has contacted CMS for more guidance.
 
The following list includes the added codes in bold font and the deleted codes in red font with a strikethrough.
 
71271
Computed tomography, thorax, low dose for lung cancerscreening, without contrast material(s)
74263
Ct colonography screening
76706
Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
76977
Us bone density measure
77063
Breast tomosynthesis bi
77067
Scr mammo bi incl cad
77078
Ct bone density axial
77080
Dxa bone density axial
77081
Dxa bone density/peripheral
77085
Dxa bone density axl vrt fx
80061
Lipid panel
80081
Obstetric panel inc hiv tstg
81528
Oncology colorectal scr
82270
Occult blood feces
82947
Assay glucose blood quant
82950
Glucose test
82951
Glucose tolerance test (gtt)
83036
Hemoglobin glycosylated a1c
86592
Syphilis test non-trep qual
86593
Syphilis test non-trep quant
86631
Chlamydia antibody
86632
Chlamydia igm antibody
86704
Hep b core antibody total
86706
Hep b surface antibody
86780
Treponema pallidum
87110
Chlamydia culture
87270
Chlamydia trachomatis ag if
87320
Chlmyd trach ag ia
87340
Hepatitis b surface ag ia
87341
Hep b surface ag neutrlzj ia
87490
Chlmyd trach dna dir probe
87491
Chlmyd trach dna amp probe
87590
N.gonorrhoeae dna dir prob
87591
N.gonorrhoeae dna amp prob
87800
Detect agnt mult dna direc
87810
Chlmyd trach assay w/optic
87850
N. gonorrhoeae assay w/optic
90460
Im admin 1st/only component
90461
Im admin each addl component
90471
Immunization admin
90472
Immunization admin each add
90473
Immune admin oral/nasal
90474
Immune admin oral/nasal addl
90480
Admn sarscov2 vacc 1 dose
90653
Iiv adjuvant vaccine im
90656
Iiv3 vacc no prsv 0.5 ml im
90657
Iiv3 vaccine splt 0.25 ml im
90658
Iiv3 vaccine splt 0.5 ml im
90660
Laiv3 vaccine intranasal
90661
Cciiv3 vac abx fr 0.5 ml im
90662
Iiv no prsv increased ag im
90670
Pcv13 vaccine im
90671
Pcv15 vaccine im
90673
Riv3 vaccine no preserv im
90677
Pcv20 vaccine im
90684
Pcv21 vaccine im
90732
Ppsv23 vacc 2 yrs+ subq/im
90739
Hepb vacc 2/4 dose adult im
90740
Hepb vacc 3 dose immunsup im
90743
Hepb vacc 2 dose adolesc im
90744
Hepb vacc 3 dose ped/adol im
90746
Hepb vaccine 3 dose adult im
90747
Hepb vacc 4 dose immunsup im
90759
Hep b vac 3ag 10mcg 3 dos im
91304
Sarscov2 vac 5mcg/0.5ml im
91318
Sarscov2 vac 3mcg trs-suc im
91319
Sarscv2 vac 10mcg trs-suc im
91320
Sarscv2 vac 30mcg trs-suc im
91321
Sarscov2 vac 25 mcg/.25ml im
91322
Sarscov2 vac 50 mcg/0.5ml im
96380
Admn rsv monoc antb im cnsl
96381
Admn rsv monoc antb im njx
96156
Hlth bhv assmt/reassessment
96158
Hlth bhv ivntj indiv 1st 30
96159
Hlth bhv ivntj indiv ea addl
96164
Hlth bhv ivntj grp 1st 30
96165
Hlth bhv ivntj grp ea addl
96167
Hlth bhv ivntj fam 1st 30
96168
Hlth bhv ivntj fam ea addl
97802
Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803
Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804
Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
99406
Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407
Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99497
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
99498
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
G0008
Admin influenza virus vac
G0009
Admin pneumococcal vaccine
G0010
Admin hepatitis b vaccine
G0011
Hiv prep counsel, md 15-30m
G0012
Injection of hiv prep drug
G0013
Hiv prep counsel, clin staff
G0101
Ca screen;pelvic/breast exam
G0102
Prostate cancer screening; digital rectal examination
G0103
Psa screening
G0104
Ca screen;flexi sigmoidscope
G0105
Colorectal scrn; hi risk ind
G0106
Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
G0108
Diabetes outpatient self-management training services, individual, per 30 minutes
G0109
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
G0120
Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema
G0121
Colon ca scrn not hi rsk ind
G0123
Screen cerv/vag thin layer
G0124
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
G0130
Single energy x-ray study
G0136
Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes
G0141
Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
G0143
Scr c/v cyto,thinlayer,rescr
G0144
Scr c/v cyto,thinlayer,rescr
G0145
Scr c/v cyto,thinlayer,rescr
G0147
Scr c/v cyto, automated sys
G0148
Scr c/v cyto, autosys, rescr
G0270
Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes
G0271
Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes
G0296
Visit to determ ldct elig
G0327
Colon ca scrn;bld-bsd biomrk
G0328
Fecal blood scrn immunoassay
G0402
Initial preventive exam
G0403
Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0404
Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0405
Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination
G0432
Eia hiv-1/hiv-2 screen
G0433
Elisa hiv-1/hiv-2 screen
G0435
Oral hiv-1/hiv-2 screen
G0438
Ppps, initial visit
G0439
Ppps, subseq visit
G0442
Annual alcohol misuse screening, 5 to 15 minutes
G0443
Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes
G0444
Annual depression screening, 5 to 15 minutes
G0445
High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes
G0446
Intens behave ther cardio dx
G0447
Behavior counsel obesity 15m
G0472
Hep c screen high risk/other
G0473
Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes
G0475
Hiv combination assay
G0476
Hpv combo assay ca screen
G0499
Hepb screen high risk indiv
G0513
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
G0514
Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
G9880
Em 5 percent wl
G9881
Em 9 percent wl
G9886
In-person attendance g code
G9887
Distance learning attendance
G9888
5% wl maintnd from bsline wt
J0739
Hiv prep, inj, cabotegravir
J0750
Hiv prep, ftc/tdf 200/300mg
J0751
Hiv prep, ftc/taf 200/25mg
J0799
Hiv prep, fda approved, noc
P3000
Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
P3001
Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician
Q0091
Obtaining screen pap smear
Q2039
Influenza virus vaccine, nos
 
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