UCR 270: The G2211 Payment Problem – Coding Mistakes That Hurt More Than You Think

January 2, 2026 

In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structure affects physician compensation, and when to fight for carve-outs. They also explore why every urology practice should reassess payer mix and drop underperforming contracts when appropriate.