Medicare AdvantageBilling CodesHigh impact
Ambetter Health Billing Code Update for HCPC Codes G2211 & G2212
Ambetter·Claims & Billing
Effective date
Apr 1, 2026
We identified it
Aug 26, 2026
Summary
Ambetter Health will no longer cover HCPCS add-on codes G2211 (complexity add-on for established patient relationships) and G2212 (prolonged E/M services) effective April 1, 2026. Billing teams must transition to standard CPT E/M codes (99202–99205, 99211–99215) for all Ambetter claims on or after this date.
Action Required
By March 31, 2026: Billing team must update billing software and claim submission protocols to stop billing HCPCS codes G2211 and G2212 to Ambetter Health. Effective April 1, 2026, route all claims using G2211 or G2212 to use standard CPT E/M codes (99202–99205, 99211–99215) as appropriate. Update encounter templates and provider education materials to reflect the code change. Beginning April 1, 2026, any claims submitted with G2211 or G2212 to Ambetter will be denied. Contact your Ambetter Provider Relations Representative if clarification is needed on appropriate E/M code selection.