G2212 Insurance Policy Changes

HCPCS G2212 is officially defined as "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, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)." HCPCS G2212 is referenced in 2 tracked payer policy changes from Sentara Health Plans and Health Net. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G2212 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.