Optimize your primary care practice revenue with comprehensive billing expertise. We specialize in preventive care, chronic care management, and the full spectrum of family medicine billing requirements to maximize your reimbursements.
Our team specializes in primary care billing with deep expertise in E/M coding, preventive services, and chronic care management programs that generate recurring monthly revenue.
Primary care practices face unique billing complexities with preventive services, chronic care management, and care coordination requirements.
The 2021 MDM-based E/M guidelines require understanding of data reviewed, diagnoses addressed, and risk of management to select the correct level.
Chronic care management (CCM) and remote patient monitoring (RPM) represent significant revenue but require specific enrollment, consent, and time documentation.
Same-day preventive and problem-oriented visits require modifier 25 and separate documentation to bill both services correctly.
Medicare AWV (G0438/G0439) requires specific elements including health risk assessment, personalized prevention plan, and screening schedules.
Immunization billing requires separate codes for vaccine product and administration, with age-specific and counseling-based variations.
TCM codes (99495/99496) after hospital discharge require interactive contact within 2 business days and a face-to-face visit within 7-14 days.
| Code | Description | Notes | Common Issues |
|---|---|---|---|
| 99213/99214 | Office visit, established patient, low/moderate complexity | Most common primary care E/M codes | Undercoding 99214 when MDM clearly supports moderate complexity |
| 99215 | Office visit, established patient, high complexity | High MDM - 2 or more chronic conditions with risk | Underused in complex patients with multiple comorbidities |
| G0438/G0439 | Annual Wellness Visit initial and subsequent | Medicare-specific preventive benefit - not a physical exam | Billing as 99395 instead of AWV - different benefit and reimbursement |
| 99490 | Chronic Care Management, first 20 minutes per month | Requires patient consent, care plan, 20 or more minutes monthly | Significantly underutilized - average practice recovers significant monthly revenue |
| 99495/99496 | Transitional Care Management, 14-day and 7-day | Contact within 2 business days of discharge plus face-to-face visit | Most commonly missed high-value primary care code |
| 90460 | Immunization administration with counseling, first vaccine | Separate from vaccine product code - higher rate when physician counsels | Underbilling by using 90471 instead of 90460 when counseling occurs |
CPT codes for reference only.
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