Is G2211 going away in 2027? What modifier B1 means for your claims

Yes. For Medicare visits on or after January 1, 2027, G2211 goes away, and modifier B1 goes on the office or home visit code instead. B1 follows the same rules, but CMS says it raises the visit's payment by 16% instead of adding a flat amount, and by our math that shrinks the add-on on a 99212 or 99213.

Keep billing G2211 for visits through December 31, 2026. G2211 is an add-on code with its own line on the claim. B1 is a modifier, a two-character code like 25 that's added to a line, so in January the add-on moves onto the visit's line.

For example, say one of your doctors bills G2211 on 60 Medicare visits a month. At $17.37 each, G2211's 2026 national rate, that one line brings in about $1,042 a month, or about $12,500 a year. If your superbill still sends G2211 on January visits, Medicare won't pay that line, and those visits go out without B1.

This is Medicare's rule, from the 2027 Physician Fee Schedule final rule CMS released on November 4, 2026. Other insurance companies set their own.

What does a Medicare claim with modifier B1 look like?

The visit and the add-on become one line. B1 goes on the same visits that qualify for G2211 today. Those are new or established patient office visits (99202 through 99215) and home visits (99341 through 99350), when the clinician is the patient's ongoing source of care or is treating one serious or complex condition over time. CMS ties B1 to that relationship, so how sick the patient is doesn't decide it.

Here is how four common visits change on the claim.

Visit	2026 claim	2027 claim
Follow-up with the patient's regular primary care doctor	99214, plus G2211 on its own line	99214 with modifier B1, one line
Office visit and a knee injection (20610) the same day	99213 with modifier 25, plus 20610. No G2211	99213 with modifier 25, plus 20610. No B1
Problem visit on the same day as an annual wellness visit	G0439, 99213 with modifier 25, plus G2211	G0439, plus 99213 with modifiers 25 and B1
Telehealth follow-up with the regular doctor	99213 with your usual telehealth coding, plus G2211	99213 with B1 added to your usual telehealth coding

CMS confirmed in the rule that B1 can go on a telehealth visit, as long as the visit meets the other requirements. The visit level doesn't decide eligibility either. B1 can go on a 99212, a 99214 or a 99215.

How much does modifier B1 pay compared with G2211?

Less than G2211 on a 99212 or 99213. By our math from CMS's national numbers, B1 adds about $7 to $15 to a 99213, against the $17.37 G2211 paid in 2026, and about $4 to $9 to a 99212. On a 99214 or 99215, it depends on a question CMS hasn't settled.

G2211 pays the same amount on every visit, $17.37 in 2026 at the national rate before your local adjustment. CMS's own table shows that flat amount adds about 29% to a 99212 but only 9% to a 99215. B1 adds 16%, so the extra grows with the visit level. On a 99212, the add-on goes from about 29% of the visit to 16% or less.

The open question is what the 16% is taken from. The rule text takes 16% of the visit's whole value. The spreadsheet CMS posted with the rule takes 16% of only the part that pays for the clinician's work, which comes to about half as much on a 99213 or 99214. That's why the 99213 range runs from about $7 to $15. Either way it's under $17.37, so if most of your G2211 visits are 99213s, plan for B1 to bring in less.

Some commenters asked CMS to keep a flat amount. One told CMS a percentage would move money away from 99213 and 99214, which the commenter said make up most primary care visits. CMS kept the 16% and said it may look at it again in a later rule.

In a Medicare Shared Savings Program ACO or CMS's LEAD model? Your clinicians can use modifier B2 instead, which CMS says adds 32%. B2 is optional, and it can go on visits for any Medicare patient who qualifies, including patients who aren't assigned to the ACO.

B1 rides on the visit code and its dollars rise and fall with the level, so the level billed still has to be the one the note supports, up or down. See how to check a 99213 vs. 99214 note. For established-patient visits, Cortex Lens reads each Practice Fusion note and shows the level it supports while the chart is still open, before the claim goes out.

Can you bill G2211 or B1 with modifier 25?

Only in a few cases. Modifier 25 marks an office visit as separate from a procedure or other service the same day. Medicare doesn't pay G2211 on a visit billed with modifier 25 unless the same-day service is an annual wellness visit, a Welcome to Medicare visit (the IPPE), a vaccine given that day, or another Medicare Part B preventive service. CMS kept those same limits for B1 and B2 in 2027.

A second January change hits visits billed with modifier 25. When one is billed with a procedure that has a 0-day global period, meaning no follow-up days are bundled into it, Medicare will pay the higher-paid service in full and the other at 80%. That applies when the same clinician does both, or a clinician of the same specialty in your group. A knee injection (20610) is one of these procedures. See when a same-day visit stands apart from a procedure.

Can you bill G2211 or B1 with an annual wellness visit?

Yes, on the separate office visit. If the patient also needs care for a problem at the wellness visit, bill the office visit with modifier 25, and G2211 can go with it. In 2027, B1 goes on that office visit line. It doesn't go on the wellness visit code (G0438 or G0439), because B1 applies only to office and home visit codes.

The office visit still needs its own problem-focused work in the note. See when a wellness visit can include a separate office visit.

Do Medicare Advantage and commercial plans pay B1?

Some may not. The fee schedule rule covers traditional Medicare, and CMS wrote in the rule that it doesn't directly govern how Medicare Advantage plans pay the practices they contract with. Commercial plans set their own rules too.

Before January, ask each of your bigger plans whether they'll pay B1 in 2027, keep paying G2211, or pay neither. Get the answer in writing or find it in the plan's published payment policy.

What should you change before January 1?

Fix your superbill and charge setup this week, then check the first January payments.

This week

• Add B1 to the office visit codes on your superbill, the list of codes the clinician marks for each visit, and to any charge templates. Take G2211 off for visits from January 1.
• Keep G2211 available for late December. A visit on December 30 still gets G2211, even if the claim goes out in January.
• Check how many modifiers your visit lines can hold. If a line needs more than four, CMS says to put modifier 99 in the fourth spot and list all of that line's modifiers in the claim's narrative field.
• Get each bigger plan's answer on B1 in writing.
• If you pay clinicians by RVUs (the units Medicare uses to value each service), update that report. G2211 carries 0.33 work RVUs on its own line, and CMS posted a file with each visit's RVUs with B1 and B2 added.

In January

• Load Medicare's 2027 rates into your billing system's fee schedule as soon as CMS's fee schedule search shows them, so you can tell whether B1 paid right.
• Read the first January EOBs, the explanations of benefits Medicare sends, for visits billed with B1. If they don't pay what the lookup shows, fix your setup before the rest of the month's claims go out the same way.

Sources: The switch from G2211 to modifiers B1 and B2, who qualifies, telehealth, the modifier 25 limits, Medicare Advantage, the modifier 99 overflow, and CMS's 29% and 9% table: CY 2027 Physician Fee Schedule final rule (CMS-1848-F), released November 4, 2026. Listing modifiers in the narrative field: Medicare Claims Processing Manual, Chapter 26, item 19, issued May 27, 2026. The 16% and 32% figures, the same-day 80% payment, and the January 1, 2027 start: CMS fact sheet, November 4, 2026. B1 and B2 values by visit level, and 20610's 0-day global period: the "Mod B1 B2 Adjusted RVUs" file and Addendum B on the CMS-1848-F rule page, November 4, 2026. G2211's 2026 value: Addendum B of the CY 2026 final rule (CMS-1832-F), 0.52 total RVUs times the 2026 conversion factor of $33.4009. Rate lookup: CMS Physician Fee Schedule search, checked November 2026. The 60-visit example is made up for illustration.