G2211 Is Gone in 2027: How to Bill Modifiers B1 and B2

By Ajay Pillai, CEO, Aayur Solutions, November 11, 2026, 7 min read

What CMS Changed

CMS finalized the switch in the CY 2027 Physician Fee Schedule final rule, released November 4, 2026 and published in the Federal Register on November 9. The placeholder modifiers in the proposed rule, MOD1 and MOD2, became B1 and B2.

CMS's reasoning is that longitudinal care is part of the visit, not a separate service. A modifier also removes the extra claim line that G2211 needed.

When to Use Modifier B1

B1 is billed in the same situations as G2211. CMS kept the descriptor almost word for word. The visit must be an office/outpatient or home/residence E/M service where the practitioner either:

• serves as the continuing focal point for all of the patient's needed health care services, or
• provides ongoing care for the patient's single, serious condition or a complex condition.

The test is the relationship between patient and practitioner, not how sick the patient is that day. A one-off urgent visit with no ongoing relationship does not qualify. A primary care follow-up, or a specialist managing a patient's long-term condition, usually does. Document the ongoing relationship in the note, as auditors looked for it with G2211.

Who Gains and Who Loses

G2211 paid the same dollar amount whatever the visit level. B1 pays a share of the visit, so the add-on now rises and falls with the E/M level. The table shows the effect on an illustrative visit allowed amount. These are not Medicare rates; check your own locality's rates in the CMS fee schedule files.

What this means in practice:

• Practices with mostly 99214 and 99215 visits tend to come out ahead of the old flat add-on.
• Practices with mostly 99212 and 99213 visits may receive less per visit than G2211 paid. CMS says B1 has little overall payment impact nationally, because G2211 volume simply moves to the modifier, but your mix decides your result.
• ACO practitioners billing B2 receive twice the B1 percentage on every eligible visit.

CMS is publishing a public use file with the final rule that maps B1 and B2 to comparable RVUs at each E/M level. Use it if your physicians are paid on work RVUs, because the modifier carries no separate RVU line the way G2211 did.

Modifier B2: Rules ACOs Should Know

• Eligibility: only practitioners participating in a Medicare Shared Savings Program ACO, or Participant Providers in a LEAD Model ACO. Being in some other advanced APM does not qualify.
• Voluntary: an eligible practitioner can still bill B1.
• All Medicare patients: B2 can be billed for every fee-for-service Medicare patient the practitioner sees, not only patients assigned to the ACO.
• It counts against the ACO: CMS includes B2 claims in beneficiary assignment, historical benchmark expenditures and performance-year expenditures. Higher B2 payments raise ACO spending, which can reduce shared savings. Ask your ACO how it will treat B2 before you switch every visit.
• Check eligibility per NPI: billing B2 for a practitioner who is not on the ACO's participant list is a compliance error.

The Modifier 25 Rule Has Not Changed

Commenters asked CMS to allow B1 and B2 on any E/M visit billed with modifier 25. CMS declined. The existing rule stays: the longitudinal-care payment is not payable when the E/M visit carries modifier 25, unless the same-day service is:

• an annual wellness visit,
• vaccine administration, or
• another Medicare Part B preventive service, including the Initial Preventive Physical Examination.

Build this into your claim scrubber. A B1 on a modifier 25 visit paired with a minor procedure is the most likely B1 denial in early 2027.

A Second 2027 Change on the Same Claim Line

The same final rule adds a payment cut that touches many of the same visits. When an office/outpatient E/M visit (99202 to 99215) is billed on the same day as a 0-day global procedure, by the same practitioner or a practitioner of the same specialty in the same group, Medicare pays the highest-valued service in full and the other services at 80%.

CMS had proposed 50% and had proposed including 10- and 90-day globals. The final rule applies only to 0-day globals and uses 80%. Common examples are a visit plus an injection, or a visit plus a skin biopsy. Expect lower payments on these combinations, and do not reschedule procedures to avoid the cut; CMS said it does not find that appropriate. Our modifier guide covers when modifier 25 is supported.

Your Go-Live Checklist Before January 1

1. Update charge rules and the EHR

Retire G2211 for Medicare dates of service from January 1, 2027. Set up B1 (and B2 where eligible) as a modifier on the E/M line. Keep G2211 for 2026 dates of service that you are still billing late.

2. Fix the four-modifier limit

If a line already uses four modifiers, CMS points to the Medicare Claims Processing Manual: put modifier 99 in the fourth slot and list the rest in the claim narrative. Confirm your EHR and clearinghouse support this.

3. Add scrubber edits

Block B1 and B2 on non-E/M lines and on E/M codes other than office/outpatient and home/residence. Flag B1 with modifier 25 unless a qualifying preventive service is on the claim. Flag B2 for any NPI that is not on your ACO participant list.

4. Check other payers

Medicare Advantage and commercial plans that adopted G2211 may not recognize B1 or B2 on day one. Get each payer's written instruction, and keep billing G2211 to any payer that still requires it.

5. Re-model your Medicare revenue

Combine three changes: the new conversion factor ($32.63, down 2.31%, for most clinicians; $32.95, down 1.83%, for qualifying APM participants), your E/M level mix under B1 or B2, and the 80% rule on same-day 0-day global services. Then review physician compensation if it is based on work RVUs.

6. Watch early remittances

Review the first two weeks of January payments for B1 and B2 lines. Contractor edits on new modifiers sometimes need correction. Catching a pattern early saves a month of rework.

Frequently Asked Questions

Is G2211 going away in 2027?

Yes, for Medicare. CMS replaced add-on code G2211 with modifier B1 for services on or after January 1, 2027. B1 is appended to the office/outpatient or home/residence E/M code instead of billing a separate G2211 line.

How much does modifier B1 pay?

B1 adds 16% of the total RVUs of the E/M visit it is attached to. Unlike G2211, which paid a flat amount, B1 scales with the visit level, so it adds more to a 99215 than to a 99212.

Who can bill modifier B2?

B2 adds 32% and is available only to practitioners in a Medicare Shared Savings Program ACO or Participant Providers in a LEAD Model ACO. It is voluntary, it can be billed for all Medicare fee-for-service patients, and B2 claims count toward the ACO's assignment and expenditure calculations.

Can B1 be billed with modifier 25?

Only when the same-day service is an annual wellness visit, vaccine administration, or another Medicare Part B preventive service, including the Initial Preventive Physical Examination. Otherwise, the longitudinal-care payment is not payable on a visit with modifier 25.

Can B1 and B2 be used for telehealth visits?

Yes. CMS clarified that B1 and B2 can be used when an office/outpatient or home/residence E/M visit is furnished via telehealth, provided all other requirements are met.

What if my EHR only allows four modifiers on a claim line?

Report modifier 99 as the fourth modifier and list the additional modifiers in the claim narrative field, as the Medicare Claims Processing Manual describes.