UHC changes coverage of visit complexity code

UnitedHealthcare (UHC) has announced that starting Sept. 1, it will no longer cover a new add-on code for visit complexity in some of their business lines.

UHC will continue to pay for HCPCS code G2211 in its Medicare Advantage plans. But the nation’s largest private health insurer is suspending coverage of G2211 throughout its commercial (employer-based) lines of business and in its individual and family plans, including those offered on the Affordable Care Act (Obamacare) exchange. It’s also suspending coverage of the code for its Community Plans (Medicaid managed care) in the following states: Colorado, Florida, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New York, North Carolina, Pennsylvania, Rhode Island, Virginia, Washington, Wisconsin, and Washington, D.C.

HCPCS code G2211 reflects the time, intensity, and practice expense resources involved when physicians provide office/outpatient visits that build longitudinal relationships with patients and address the majority of a patient’s health care needs with consistency and continuity over longer periods of time. (See “G2211: Simply Getting Paid for Complexity.”)

According to UHC, for visits on or after Sept. 1, reimbursement for services associated with G2211 will be “included in its reimbursement for outpatient evaluation and management services and therefore G2211 is not separately reimbursable.”

The American Academy of Family Physicians (AAFP) continues to advocate for coverage and payment of G2211 in all plans through in-person and virtual meetings with the largest national payers. Information and resources for practices to advocate for payment of G2211 can be found on the AAFP’s G2211 Add-on Code landing page. To find coverage information for the largest national payers, download the G2211 payer matrix, or see “Which private payers cover the new G2211 code.”  

Contact your local UHC provider relations representative if you have questions about the new policy.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on June 17, 2024