Briefing · November 12, 2026

Medicare turns G2211 into a 16% modifier in 2027, and 99213 pays less

Medicare's office-visit complexity payment becomes 16% of the visit on January 1, 2027. In 2026 it is a flat add-on code, G2211, worth $17.37 at the national rate. Final rule CMS-1848-F, published in the Federal Register on November 9, 2026, replaces the code with modifier B1 and creates modifier B2, at 32%, for clinicians in certain accountable care organizations. For a psychiatrist, a 99213 with the complexity payment goes from $112.56 to $106.73, a 99214 from $152.98 to $152.16, and a 99215 from $209.76 to $212.71.

What CMS finalized

The CMS fact sheet states that the modifier "will increase the payment of the associated E/M code by 16%, instead of a flat rate, maintaining an equal percentage increase across all levels of E/M codes." G2211 carries 0.52 total non-facility RVUs whatever the visit level, which CMS calculated as a 29% increase on a 99212 and a 9% increase on a 99215.

The modifier goes "on the claim line for the associated E/M code," so the 16% is calculated on the office visit. The rule does not describe it applying to a psychotherapy add-on such as 90833.

What B1 pays on 99213, 99214 and 99215

A CMS file released with the rule lists 99213, 99214 and 99215 at 2.82, 4.02 and 5.62 total RVUs, and 3.27, 4.66 and 6.52 with B1.

National non-facility amounts at 100%, calculated by this site: total RVUs times the conversion factor ($33.4009 for 2026, $32.6286 for 2027), with B1 as 16% of the rounded visit amount.

The visit codes themselves fall in 2027, as the 2027 fee schedule briefing reported, and the complexity payment shrinks at the low end and grows at the high end. A psychiatrist whose follow-ups are mostly 99213s loses about 5% on each one that carries the modifier.

Nurse practitioners are paid up to 85% of the physician fee schedule amount under 42 CFR 414.56. On that basis a psychiatric nurse practitioner goes from $95.67 to $90.72 on a 99213 with the complexity payment, from $130.03 to $129.33 on a 99214, and from $178.29 to $180.80 on a 99215.

B1 follows the G2211 rules, regardless of specialty

CMS finalized B1 to be billed "under the same circumstances that HCPCS code G2211 is billed now." When CMS made G2211 payable in its CY2024 final rule, it wrote that "this code is not restricted to medical professionals based on particular specialties." The same rule noted that 90833, 90836 and 90838 "are add-on codes for psychotherapy that is performed with an E/M visit" and that those E/M codes "will be eligible to be billed with HCPCS code G2211."

The B1 descriptor covers care that serves as "the continuing focal point for all needed health care services" or is "part of ongoing care related to a patient's single, serious condition or a complex condition." Neither rule names psychiatric medication management as a qualifying example. Ongoing prescribing for a serious or complex psychiatric condition may fit the second clause, and that is this site's reading. CMS clarified that both modifiers can be used on telehealth visits, and that they "may only be used in conjunction with E/M visits performed in the O/O or home or residence setting," which leaves out skilled nursing facility visits.

The modifier 25 limit carries over

CMS proposed to "maintain the same limitations" for the new modifiers. The rule states that G2211 "is not payable" when the visit is reported with modifier 25, except when the same-day service is an annual wellness visit, vaccine administration or another Medicare Part B preventive service, and adds, "We are not revising this policy in this final rule." The rule does not state whether an office visit billed with a psychotherapy add-on carries modifier 25. Prescribers who bill that combination should check how their own claims are coded.

B2 pays 32% inside an ACO

Modifier B2 is limited to participants in Shared Savings Program ACOs, the LEAD model and ACO Primary Care Flex, and CMS made it available "regardless of specialty." At the national physician amount it adds $29.44, $41.97 and $58.68 to a 99213, 99214 and 99215.

How to read this briefing

This briefing has three limitations. First, the dollar amounts are this site's national calculations and the rule does not state how claims will round. CMS's rounded B1 RVUs give totals 3 to 11 cents from the table. Second, the rule does not state how the 85% limit for nurse practitioners combines with the modifier, and the figures here apply 85% first. Third, the eligibility of a medication-management visit is a reading of the descriptor, and the rule governs traditional Medicare only. Nevertheless, the percentages are final, and a prescriber can estimate the effect from their own mix of visit levels. The Medicare guide explains the RVU and conversion-factor method.

Sources: CMS fact sheet; Federal Register final rules for CY2027 and CY2024; the CMS B1 and B2 adjusted RVU file, updated November 12, 2026, on the CMS-1848-F downloads page; the CMS relative value file RVU26A; 42 CFR 414.56. Corrections via the form.