G2212
Prolonged office o/p E/M ea 15 min (Medicare)
Prolonged office or other outpatient evaluation and management service, each additional 15 minutes, Medicare's replacement for 99417. CMS 2026 wRVU 0.61, paid using the national GPCI and the 2026 conversion factor of $33.4009. Add-on only, attaches exclusively to 99205 and 99215, and only for Medicare and Medicare Advantage patients.
When to use it
Use G2212 when a Medicare patient's office visit runs long enough that total time on the date of the encounter exceeds the maximum time of the level 5 code by at least a full 15 minutes. CMS counts from the top of the old CPT time range, not the threshold, which makes G2212 harder to reach than its commercial cousin 99417: for 99205 (60 to 74 minutes) the first G2212 unit applies at 89 minutes of total time, and for 99215 (40 to 54 minutes) the first unit applies at 69 minutes.
Full guidance
Each additional full 15-minute block is another unit. Typical qualifying encounters: a new geriatric patient with multimorbidity, polypharmacy review, and family present; a complex oncology or heart failure follow-up with goals-of-care discussion; an initial cognitive workup that does not meet the structural requirements of 99483. Count all qualifying physician or QHP time on the calendar date: pre-visit chart review, the visit itself, ordering, documentation, care coordination, and results communication. Clinical staff time never counts. If the same encounter happens for a commercially insured patient, bill 99417 instead; the two codes are payer-exclusive mirrors of each other.
Documentation checklist
- ✓Document total physician or QHP time on the date of the encounter and list the qualifying activities (chart review, history and exam, counseling, ordering, documentation, coordination of care).
- ✓Total time must reach 89 minutes for a 99205 primary or 69 minutes for a 99215 primary before the first G2212 unit is billable. Each additional unit requires another full 15 minutes.
- ✓The primary E/M must be selected on time, not MDM, when you bill prolonged services. A time statement supporting the level 5 code itself is required in the same note.
- ✓Only same-date time counts toward G2212. Time spent on other calendar days is not billable under this code.
- ✓Bill the units on the same claim as the primary E/M with the same diagnosis pointers.
Common pitfalls
- !Using the 99417 thresholds (75/55 minutes) for a Medicare patient. CMS set higher trigger times for G2212 (89/69 minutes); billing the first unit at 75 minutes of a 99205 will be denied or flagged on audit.
- !Submitting 99417 to Medicare or G2212 to a commercial payer. Both directions deny. Build payer logic into your charge capture so the right prolonged code fires automatically.
- !Attaching G2212 to 99213, 99214, 99203, 99204, or to an AWV. It attaches only to 99205 and 99215.
- !Vague time documentation. "Spent extra time with patient" is unverifiable. Audit-proof language states the total minutes and itemizes the activities on the date of the encounter.
- !Forgetting that prolonged time must be exclusive of separately billed time-based services on the same date. If you bill 99497 (ACP) the same day, that time is carved out and cannot also count toward G2212.
Payer notes
Medicare and Medicare Advantage pay G2212 at roughly the same rate as one mid-level established visit, so capture matters on long encounters: a 90-minute new-patient visit billed as 99205 alone leaves the prolonged work uncompensated. Commercial payers generally do not recognize G2212 and expect 99417. For dual-eligible or secondary-payer situations, bill per the primary payer's rule. G0316, G0317, and G0318 are the parallel Medicare prolonged codes for inpatient/observation, nursing facility, and home settings; G2212 is strictly office and outpatient.