G2211 with Modifier 25: Medicare Exceptions in 2026
Medicare allows G2211 with a qualifying office E/M reported with modifier 25 for certain same-day preventive services. The exception began in 2025; a blanket never-together rule is outdated.
Start with the underlying care
G2211 describes eligible longitudinal care. It is not automatic for every primary-care visit. The base E/M and the care relationship must qualify independently.
When modifier 25 can coexist
Qualifying same-day services include an Annual Wellness Visit, vaccine administration, and Medicare Part B preventive services. Check the current CMS eligible-service list. An ordinary procedure does not automatically qualify for this exception.
Compare two encounters
An AWV with a distinct, medically necessary problem E/M may meet the preventive exception. A visit paired with a skin procedure does not gain the exception just because both happen on the same day.
Before submitting
Verify the base E/M, care relationship, same-day service, and payer policy. Document separately identifiable work supporting modifier 25. Never add diagnoses or template text to manufacture eligibility.
Frequently asked questions
Is G2211 payable with every E/M-25?
No. Check the qualifying preventive-service exception and current payer rules.
Does G2211 replace modifier 25?
No. They describe different aspects of an eligible claim.
Related code pages
Sources and next steps
Source links checked 2026-09-23. RVUDoc editorial reference; not an independently certified coding review.
Work through the base E/M decision ↗Educational reference, not billing or legal advice. Verify against payer contracts and your compliance team before claim submission. Last updated 2026-09-23.