Reimbursement
$35.40
Threshold
15m
2026 Status
Active
What is CPT Code G2212?
CPT G2212 is defined as: A Medicare-specific HCPCS code used to report prolonged office or other outpatient evaluation and management (E/M) services. This code is used for each additional 15 minutes of total time spent by the physician or other qualified health care professional (QHP) on the date of the encounter, beyond the maximum time threshold of the primary E/M codes 99205 or 99215.
This code is primarily used for E/M services. It falls under the category of HCPCS Level II / E/M and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.61
Physician Effort
PE (Non-Fac)
0.41
Practice Expense
Malpractice
0.04
Risk Factor
Total RVU
1.06
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% efficiency adjustment. As a time-based E/M service, CMS has maintained the Work RVU of G2212 to ensure providers are equitably compensated for intensive clinical effort.
cpt divergence
In 2026, the delta between CPT (99417) and CMS (G2212) time thresholds remains a critical audit area for revenue cycle managers.
conversion factor
Utilizes the 2026 Non-QP rate of $33.40.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
time threshold 99205
For a NEW patient, G2212 can only be billed once the total time reaches 89 minutes (74 mins max for 99205 + 15 mins for first unit of G2212).
time threshold 99215
For an ESTABLISHED patient, G2212 can only be billed once the total time reaches 69 minutes (54 mins max for 99215 + 15 mins for first unit of G2212).
medicare only
This code is strictly for Medicare and payers that follow Medicare rules. Most commercial payers use CPT 99417 instead.
included activities
Includes all time spent by the provider on the date of the encounter, including non-face-to-face time (e.g., record review, coordination of care).
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Exempt from the mandatory -2.5% efficiency cut. Use for Medicare claims instead of CPT 99417.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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