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See a sample rate comparisonHCPCS G2212 Fee Schedule
Medicare rates as of October 2026
HCPCS G2212 is classified under Procedures / Professional Services, in the Evaluation and Care Management Services subgroup.
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Evaluation and Care Management Services |
| Complexity Level | Low |
| Medicare Fee Schedule | $34.07 national non-facility rate (2026) · View Medicare rates for G2212 |
| Medicaid Fee Schedule | $29.16 median of the 8 states in the free preview · View Medicaid rates for G2212 |
National average reimbursement for HCPCS G2212 by major payers:
$38.67
BCBS / Anthem
$43.04
UnitedHealthcare
$39.25
Aetna
$34.61
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS G2212.
HCPCS G2212
5 of 25 sample ratesHigher to lower in this preview
Adriana Lopez
Magella Medical Associates Billing Inc
$120.70Published ratePatricia Campbell
Texas Childrens Physician Group
$67.88Published rateElizabeth Bailey
U T Physicians
$47.63Published rateDeandra Chambliss
U T Physicians
$35.77Published rateAshlyn Weninger
Texas Childrens Physician Group
$28.12Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G2212 vs. Other Evaluation and Care Management Services Codes
The table lists codes related to G2212. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G2211-HCPCS | Low | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to home or residence or office/outpatient evaluation and management service, new or established) |
| G2212-HCPCS | Low | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99205, 99215, 99483 for office or other outpatient evaluation and management services) (do not report g2212 on the same date of service as 99358, 99359, 99415, 99416). (do not report g2212 for any time unit less than 15 minutes) |
| G2213-HCPCS | Low | Initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services (list separately in addition to code for primary procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G2212. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G2212 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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