Why Primary Care billing is different.
Primary Care billing expertise.
- E/M level selection by medical decision-making or time
- Annual wellness visit and preventive exam billing
- Chronic care, principal care and transitional care management
- Same-day preventive and sick visit billing with modifier -25
- Vaccine and administration coding
- In-office lab and testing claims
- Risk adjustment and HCC documentation support
- Patient statement and balance collection workflows
Common Primary Care codes we work with.
| Code | Description |
|---|---|
99213 | Office or outpatient visit, established patient, low level of medical decision-making |
99214 | Office or outpatient visit, established patient, moderate level of medical decision-making |
G0438 | Annual wellness visit, including personalized prevention plan, initial visit |
G0439 | Annual wellness visit, including personalized prevention plan, subsequent visit |
99396 | Periodic preventive medicine reevaluation, established patient, age 40-64 years |
99490 | Chronic care management, first 20 minutes of clinical staff time per calendar month |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processPrimary Care billing process.
Scheduling and Eligibility
- Real-time eligibility checks before every visit
- Preventive benefit frequency verification
- Copay and deductible collection at check-in
- Updated demographics and insurance on file
Coding and Charge Capture
- E/M level review against documentation
- Preventive and problem visit separation
- Care management time tracking and billing
- Vaccine, lab and procedure capture
Claim Submission
- Scrubbing for frequency and bundling edits
- Diagnosis specificity for chronic conditions
- Modifier checks on same-day services
- Daily electronic submission
Denials and Patient Balances
- Frequency and coverage denial appeals
- Corrected claims for coding issues
- Clear patient statements and follow-up
- Payment plan setup when needed
Performance Reporting
- E/M level distribution by provider
- Wellness and care management capture rates
- Payer reimbursement and denial trends
- Patient balance and collection reports
Primary Care billing FAQs.
Can we bill a preventive exam and a sick visit on the same day?
Yes, when a significant problem is addressed beyond the preventive service. The problem-oriented E/M is billed with modifier -25, and the documentation should clearly separate the two services.
What is the difference between an annual wellness visit and a physical?
Medicare's annual wellness visit focuses on a personalized prevention plan and does not include a full physical exam. Commercial plans typically cover preventive physicals instead, so we bill the service that matches the patient's coverage.
Is chronic care management worth billing?
For practices with many patients with two or more chronic conditions, chronic care management adds recurring monthly revenue for work your staff often already does. We help set up consent, time tracking and documentation so it's billed correctly.
How do you choose E/M levels?
Office E/M levels are selected based on medical decision-making or total time on the date of service. We review documentation to confirm the level billed is supported, which protects you from both under-coding and audit risk.