Medicare G2211 Code Shows 43% Specialist Uptake in First Year, Raising Questions on Primary Care Incentives

Medicare introduced G2211 in 2024 to add roughly $16 per visit for longitudinal, relationship-based care, aiming to offset fee-for-service distortions that favor procedures over cognitive work. Ganguli's review of early claims found solid uptake, with one in four Medicare-billing physicians using the code, but the distribution deviated from intent: specialists accounted for 43% of billings, primary care 40%, and non-physician clinicians the rest. Visits often addressed focused issues like acid reflux rather than comprehensive management.

This pattern echoes longstanding imbalances in the Physician Fee Schedule, where specialty lobbying has historically protected higher procedural payments. Related studies in JAMA Health Forum and Health Affairs document how such misalignments contribute to primary care workforce shortages and reduced access, particularly for Medicare patients managing multiple chronic conditions. The code's inability to restrict billing by specialty allowed broader use, diluting its targeted investment in team-based primary care.

Future data releases from CMS will clarify whether utilization shifts toward primary care or if additional policy levers, such as eligibility criteria or bundled payments, are needed to realign incentives with outcomes.