G2211 Becomes Modifier B1 and B2 in 2027: What Changes

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

G2211 is Medicare's visit complexity add-on for office and outpatient visits where a clinician is the continuing focal point of a patient's care. CMS's CY2027 final rule retires it on January 1, 2027 and replaces it with modifier B1, which raises the visit payment by 16%, and modifier B2, which raises it by 32% for Shared Savings Program and LEAD ACO participants.

I've worked both sides of the patient call, and what stands out about G2211 is that it pays for a relationship, not a task. The 2027 change keeps that idea and changes the math.

Key facts

• CMS released the CY2027 Physician Fee Schedule final rule on November 4, 2026, and it published in the Federal Register on November 9, 2026, effective January 1, 2027 (CMS fact sheet, Federal Register).
• Modifier B1 replaces G2211 and raises the associated E/M payment by 16%, instead of paying a flat add-on amount (CMS fact sheet).
• Modifier B2 raises the associated E/M payment by 32% and is open only to Shared Savings Program ACO participants and LEAD Model Participant Providers (CMS fact sheet).
• B2 is voluntary and can be billed for any Medicare beneficiary those clinicians see, not only patients assigned or aligned to the ACO (CMS fact sheet).
• B2 claims count toward beneficiary assignment, historical benchmark and performance year spending in both the Shared Savings Program and LEAD (CMS fact sheet).
• The 2027 conversion factor is $32.63 for clinicians who aren't qualifying APM participants (down 2.31% from $33.40) and $32.95 for those who are (down 1.83% from $33.57) (CMS fact sheet).
• G2211 itself was delayed by statute and took effect in CY2025, so 2026 is its second full year (CMS fact sheet).

What is G2211, and what replaces it in 2027?

G2211 is a Medicare add-on code that pays for the extra complexity of being a patient's continuing point of care. CMS finalized it in the CY2021 fee schedule, a statutory delay held it back, and it became payable in CY2025. In 2027 it stops existing as a separate code.

In its place, CMS finalized a modifier that you append to the base E/M visit. The proposed rule used a placeholder called MOD1. The final rule names it B1. The clinical test hasn't changed. Trade press reports that B1 applies in the same situations as G2211: the clinician is the continuing focal point for all of the patient's needed care, or provides ongoing care for a single serious or complex condition (Medical Economics).

CMS gave a plain reason for the swap. It wants billing that's easier for beneficiaries to follow, and it wants an equal percentage increase across all levels of E/M visit instead of one flat amount.

How do modifiers B1 and B2 pay?

Both modifiers pay a percentage of the E/M visit they're attached to. B1 adds 16%. B2 adds 32%. The extra payment now grows with the visit level.

Here's a worked example with round numbers. These aren't Medicare rates, only arithmetic so you can see the mechanics:

1. Assume an E/M visit pays $100 before the modifier.
2. With B1, the visit pays $100 + (16% of $100) = $116. The add-on is $16.
3. With B2, the visit pays $100 + (32% of $100) = $132. The add-on is $32.
4. Assume a higher level visit pays $190. B1 adds $30.40 and B2 adds $60.80.

Under G2211, the add-on didn't change with the visit level. Under B1, a level 5 visit earns a larger add-on than a level 2 visit. CMS expects little overall payment effect from B1 because volume that bills G2211 today simply moves to the modifier.

Who can bill B2?

Only two groups can bill B2: clinicians participating in a Medicare Shared Savings Program ACO, and Participant Providers in the Long-term Enhanced ACO Design (LEAD) Model. CMS's reasoning is that these clinicians carry extra costs, including total cost of care accountability and quality reporting that line up with longitudinal care and care coordination.

Three details matter for planning:

• Not limited to assigned patients. B2 can be billed for any beneficiary the ACO clinician sees, as long as the visit involves the qualifying longitudinal complexity.
• Voluntary. An eligible clinician can still bill B1 instead.
• Program membership decides it. Advanced APM status by itself doesn't qualify you. A practice outside the Shared Savings Program and LEAD gets B1 only (Medical Economics).

There's one more consequence. Claims billed with B2 are included in assignment, benchmark and performance year expenditure calculations. That means the extra payment feeds back into the ACO's own spending math. If you're in an ACO, ask your ACO leadership how it plans to handle that before you change your billing. For background on the model that starts next year, read our explainer on what the LEAD model means for practices.

Will B1 pay more or less than G2211 did?

It depends on the visit level. The American Osteopathic Association's summary of the rule says B1 produces a modest increase for 99214 and 99215 compared with the current flat approach, and a slight reduction when it's appended to lower level visits such as 99212 and 99213 (AOA summary).

That's the direct result of switching from a flat amount to a percentage. A practice whose visit mix leans toward level 4 and 5 visits should see a small gain. A practice that bills mostly level 2 and 3 visits may see a small loss.

Don't treat any single dollar figure as final yet. The conversion factor is also falling by 2.31% for most clinicians, so every E/M base payment moves down a little at the same time. Check the CMS fee schedule files and your Medicare Administrative Contractor (MAC) claims instructions for the exact January rates before you model revenue.

Does the modifier 25 restriction carry over?

CMS's fact sheet doesn't spell this out, so verify it before January. Today, G2211 isn't payable when the base E/M visit carries modifier 25, with exceptions for services such as an Annual Wellness Visit, vaccine administration or another eligible Medicare Part B preventive service. Trade press reports that CMS proposed to carry the same restriction over to B1 and B2 (Physicians Practice, Medical Economics).

Keep it separate from a different modifier 25 policy in the same rule. CMS finalized a payment reduction when a separately identifiable office or outpatient E/M visit is billed on the same day as a procedure with a 0 day global period. The higher paid service gets 100% and the other gets 80%. CMS dropped the proposed 10 day and 90 day global periods and moved the reduction from 50% to 20% (CMS fact sheet).

What this means for your practice

Start with the plumbing. Your billing system, EHR and claim scrubber need modifier B1 (and B2 if you're eligible) in their code tables before January 1. Ask your billing team to remove G2211 from any 2027 claim templates and to update denial edits.

Then look at documentation. Because the clinical standard is unchanged, the note language that supports G2211 today should keep supporting B1. Confirm that with your MAC, since the January claims instructions will govern.

Finally, check compensation plans. If your clinicians are credited for G2211 today, decide how the 16% on a B1 visit will be credited.

The longitudinal relationship that B1 pays for is built between visits, not only during them. That's the idea behind the monthly care management programs Medicare already pays for. HANA Health makes those monthly patient calls and writes the notes for your clinician to review. We've also covered what else the rule changes in CY2027 care management billing and RPM and RTM.

Frequently asked questions

Can I still bill G2211 in December 2026?

Yes. G2211 stays payable under current rules through the end of 2026. The change takes effect for services on or after January 1, 2027 (Federal Register).

Do I need a different clinical reason to use B1?

No. Reports on the final rule say the clinical criteria carry over from G2211. You still need to be the continuing focal point for the patient's care or provide ongoing care for a serious or complex condition (Medical Economics).

Can an ACO clinician bill B2 for patients who aren't assigned to the ACO?

Yes. CMS says B2 isn't limited to assigned or aligned beneficiaries, provided the visit involves qualifying longitudinal complexity (CMS fact sheet).

Do Medicare Advantage and commercial plans have to follow B1 and B2?

The rule sets Medicare Part B fee schedule policy. Medicare Advantage and commercial plans set their own payment and coding policies, so check each contract and plan bulletin.

Is B2 worth choosing over B1?

B2 pays a higher percentage, but it feeds into ACO spending calculations. Talk with your ACO before you decide, because the decision may be made at the ACO level.

Sources

1. Centers for Medicare & Medicaid Services, Calendar Year (CY) 2027 Medicare Physician Fee Schedule Final Rule fact sheet, November 4, 2026.
2. Federal Register, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule (CMS-1848-F), 91 FR 70992, November 9, 2026.
3. American Osteopathic Association, CY 2027 Medicare Physician Fee Schedule and Quality Payment Program Final Rule initial summary, November 2026.
4. Medical Economics, Goodbye G2211, hello B1 and B2: what the 2027 Medicare Physician Fee Schedule means for primary care, November 5, 2026.
5. Physicians Practice, Medicare's final 2027 fee schedule cuts pay and changes same-day and G2211 billing for practices, November 4, 2026.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. Want to talk through how care management fits your practice? Book a discovery call.