## **What is HCPCS code G2212?**
HCPCS code G2212 is a prolonged care code (add-on) or prolonged service add-on code used primarily for Medicare billing to account for medically necessary, prolonged time spent during an Office or Other Outpatient Evaluation and Management (E/M) visit.
The code's full description is: "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 (list separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (Do not report G2212 for any time unit less than 15 minutes)."
To elaborate, it is an add-on code used to report time that extends beyond the maximum time associated with the highest level of an outpatient E/M visit, when the E/M visit level is selected based on total time.
## **HCPCS code G2212 documentation requirements**
The medical record documentation must clearly support the use of prolonged services. Key documentation requirements include:
- **Medical necessity**: The documentation must objectively determine the medical necessity of the prolonged service.
- **Total time spent**: Documenting the total time spent by the reporting practitioner on the date of the E/M service, including both face-to-face and non-face-to-face work. It's often best practice to document the specific activities and the time spent on them, or at least the start and end times of the total service time.
- **Time threshold**: The documentation must show that the total time exceeded the minimum time required for the highest-level E/M code (99205 or 99215) by at least 15 minutes before the first unit of G2212 can be billed. Partial increments do not qualify.
## **G2212 billing requirements**
To properly bill for HCPCS code G2212, the following guidelines must be considered:
- **Add-on code**: G2212 is an add-on code and must be billed in addition to the base E/M service code (99205 or 99215).
- **Payer specific**: G2212 was created by CMS and is specifically for Medicare (and often Medicare Advantage plans) when using time to select the E/M level. Commercial payers may follow different guidelines.
- **Time-based selection only**: It is only reported when the E/M visit level is determined based on the total time spent by the reporting practitioner.
- **Threshold rule**: A full 15 minutes of prolonged time must be met beyond the maximum time of the Level 5 E/M visit to report one unit of G2212. Time less than 15 minutes beyond the threshold should not be reported.
## **Other relevant codes**
- **CPT 99205**: Under new patient
- **CPT 99215**: Under established patient
- **CPT 99417**: Under prolonged service with or without direct patient contact on the date of an evaluation and management service
- **G2211**: Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established)
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