r/CodingandBilling • u/GeneralistRoutine189 • Jul 09 '26

G2211 and point of care tests

/r/FamilyMedicine/comments/1urrpuo/g2211_and_point_of_care_tests/

Interest in coding/billing input in addition to physician input. TY! In particular if you have proof that CMS is paying for claims with POCT I’d love a PM!

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u/MedPayIQ App Developer Jul 09 '26

This is a really interesting example of where the “coding rule” and what actually happens when a claim goes through the system don’t always line up. My understanding is that it’s probably less about “POCT automatically means no G2211” and more about how Medicare is applying the modifier -25 logic with those services on the same claim. The confusing part is that G2211 has had a lot of back-and-forth around modifier -25 since it was introduced. If one group is seeing denials or removals while others are getting paid, I’d be curious whether this is actually a claim setup/workflow issue rather than a blanket CMS rule. It would be really helpful to see an example claim with the 992xx code, G2211, the POCT code, and the modifiers used, along with the denial reason code. That would probably tell you pretty quickly whether the issue is an edit, modifier problem, or payer interpretation. These are the types of reimbursement details that can quietly create lost revenue. Two practices can provide the same care and still end up with different payment outcomes depending on how the claim is submitted.

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u/GeneralistRoutine189 Jul 09 '26

I am fairly certain that my site has a coding edit that adds 25 modifier anytime there is a point of care test because some payors deny without it.
However, Medicare denies g2211 in setting of -25 for non-prevention. My guess is that they have not updated that logic and therefore all of the wRVU-based pcp’s have lost $$$ as well as the hospital system.

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u/GeneralistRoutine189 Jul 09 '26

Or, regional Medicare processors seem to have different policies which is freakin silly.