G2211 becomes modifier B1 in 2027: what changes and what doesn’t

Starting with services on January 1, 2027, Medicare will no longer pay HCPCS code G2211, the visit complexity add-on. The same visits still get extra payment, but it is reported as modifier B1 on the office or home visit line instead of a separate line. Clinicians in a Medicare Shared Savings Program ACO, ACO PC Flex or the LEAD model may use modifier B2, which pays twice as much. The rule that blocks the add-on when the visit carries modifier 25 does not change.

CMS finalized this in the 2027 Physician Fee Schedule final rule, published November 9, 2026. This guide covers the rule as it stands through December 31, 2026, what changes on January 1, an open question about how much B1 pays, and what to update in your system before the first 2027 claim goes out. Rules are as of November 2026.

The rule through December 31, 2026

Medicare began paying G2211 on January 1, 2024. It is an add-on to an office or outpatient visit (99202–99205, 99211–99215) and, since 2026, to a home or residence visit (99341, 99342, 99344, 99345, 99347–99350). It pays for the extra work that comes from an ongoing relationship with the patient, not from anything about a single visit.

Per CMS’s G2211 FAQ, the relationship qualifies when the billing clinician is either:

• the continuing focal point for all of the patient’s needed care (the way a primary care clinician is), or
• providing ongoing care for a single serious condition or a complex condition. CMS’s own examples are an infectious disease physician managing a patient’s HIV and a clinician in the ongoing care of a patient with sickle cell disease.

It is not limited to primary care. CMS says any clinician who can bill Medicare for these visits may report it, in any specialty. What rules it out is a relationship that is discrete, routine or time-limited. CMS lists examples such as removing a mole, treating a simple virus, counseling for seasonal allergies or treating a fracture, where the clinician has not taken on ongoing care.

CMS has not set extra documentation requirements for G2211. It expects the record and claims history (diagnoses, assessment, plan of care, other codes) to show the relationship.

The modifier 25 limit

Medicare does not pay G2211 when the visit is billed with modifier 25 (a significant, separately identifiable visit on the same day as a procedure or other service by the same clinician). Since January 1, 2025 there is one exception: G2211 is payable with a modifier 25 visit when the other same-day service is:

• an annual wellness visit,
• vaccine administration, or
• another Medicare Part B preventive service, including the Initial Preventive Physical Examination (“Welcome to Medicare” visit).

Since January 1, 2026 the same exception covers home or residence visits. The exception is about Medicare-covered preventive services. A routine physical (99381–99397) is not a Medicare-covered service, so it does not open the exception.

What changes on January 1, 2027

A few details from the final rule:

• B1 and B2 work only with office or outpatient visits and home or residence visits. They cannot be used with visits in other settings such as a skilled nursing facility, and an RHC or FQHC does not get separate payment for them.
• B2 is optional. An ACO clinician chooses B1, B2 or neither, based on the visit, and can use B2 for any Medicare patient they see, not only patients assigned to the ACO. CMS says being in an ACO does not by itself make every visit qualify.
• B2 does not extend to other Advanced APMs or other Innovation Center models.

How much B1 pays: an open question

CMS’s reason for the change is that a flat add-on gave a bigger boost to low-level visits than to high-level ones. Its fix is a percentage. The fact sheet and the rule text describe B1 as 16% of the visit, and the rule’s impact analysis says “16 percent of the total RVUs for the E/M service”. That figure was set as a weighted average of what G2211 added, adjusted for budget neutrality.

The public use file CMS posted with the rule to show B1 and B2 values reads differently. Its footnote says B1 raises the work RVU by 16%, and its numbers add 16% of the work RVU only. That produces a much smaller amount.

In dollars at the Long Island locality (locality 02, non-QP conversion factor, our calculation from CMS’s RVU and GPCI files), B1 adds about $7.22 to a 99213 under the file’s method or about $16.90 under the rule-text reading. G2211 added about $19.72 in 2026.

As of November 9, 2026 the two CMS sources do not match. Do not budget on either number yet. The amount Medicare actually pays will show in the 2027 fee schedule that Wellpoint Federal (formerly National Government Services, the Medicare contractor for New York) posts, and on your first 2027 remittances. Whichever number holds, the patient’s 20% coinsurance rises with it, because B1 raises the allowed amount for the visit.

How it interacts with the new 80% same-day rule

Also starting in 2027, when an office visit with modifier 25 is billed on the same day as a 0-day global procedure, Medicare pays the higher-paid service in full and the other at 80%. Commenters asked CMS how B1 and B2 fit with that. CMS’s answer was that the modifier 25 limit stays as it was in 2025 and 2026. So:

• A modifier 25 visit on the same day as a procedure gets no B1, unless the other service is an annual wellness visit, vaccine administration or another Part B preventive service.
• The 80% rule applies to the modifier 25 visit and the 0-day procedure under its own terms.

Our modifier 25 guide covers the 80% rule.

Medicare Advantage, Medicaid and commercial plans

The final rule sets traditional Medicare payment. CMS states in the rule that it does not directly govern how Medicare Advantage plans pay their contracted providers. Commenters asked CMS to make Medicare Advantage plans adopt B2; CMS declined for that reason.

What each Medicare Advantage, Medicaid managed care or commercial plan does on January 1 is not known yet. A plan that paid G2211 may:

• switch to B1 on the same date as Medicare,
• keep accepting G2211 for a while,
• or stop paying for the relationship altogether.

Check each plan’s 2027 provider bulletins and payment policies. If a plan has not said, ask your provider representative in writing before January, and keep the answer.

What to update before January 1

1. Charge templates and order sets. Remove G2211 as a separate charge for dates of service on or after January 1, 2027, and add a way to put B1 on the visit line. Keep G2211 available for late 2026 claims.
2. Modifier slots. A visit may already carry modifiers such as 25 or 95. CMS notes the claim takes four modifiers; when more are needed, put modifier 99 in the fourth position and list the rest in the claim narrative. Test this in your clearinghouse before you need it.
3. B2 setup. Turn on B2 only for clinicians who are actually in a Shared Savings Program ACO, ACO PC Flex or LEAD. Confirm the participant list with your ACO.
4. Claim edits. Build an edit that flags B1 or B2 on a modifier 25 visit unless the same-day service is an AWV, vaccine administration or Part B preventive service.
5. Payer rules. Keep a table of which plans want G2211, which want B1 and which pay neither, and map your system to it.
6. Fee schedule. Load the 2027 Medicare amounts once Wellpoint Federal posts them, and check whether your system prices B1 as a percentage or ignores it.
7. Baseline. Pull how many G2211 lines you billed and were paid in 2026, by payer. It is the only way to know in March whether B1 is paying what you expected.

The 2027 fee schedule guide lists the other changes that start the same day.

Sources

• CMS fact sheet: CY 2027 Medicare Physician Fee Schedule final rule (Nov 4, 2026)
• Federal Register: CY 2027 PFS final rule, B1 and B2 at 91 FR 71097–71104; impact analysis at 91 FR 71655 (Nov 9, 2026)
• CMS: CMS-1848-F downloads, including “Mod B1 B2 Adjusted RVUs” and Addendum B
• CMS: Frequently asked questions about E/M visit complexity add-on code G2211
• CMS MLN Matters MM13452: CY 2024 Physician Fee Schedule final rule summary
• Federal Register: CY 2025 PFS final rule, G2211 with modifier 25 at 89 FR 97856–97858
• CMS: RVU26D relative value file, 2026 October release
• Medicare Claims Processing Manual, chapter 12, §30.6.2 (preventive medicine services are noncovered)

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version. CPT® is a registered trademark of the American Medical Association. Code descriptions here are paraphrased.