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Primary care billing that captures the work you actually document

Primary care runs on volume and undercoding leaks revenue every visit. We code every E/M at the level the note supports and catch chronic care and wellness opportunities most billers miss.

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Where primary care practices lose revenue

We see the same patterns across primary care groups. The leaks are specific, recurring, and fixable with coding discipline and payer-aware claim construction.

  1. Undercoded 99213 vs 99214 visits leaking 10 to 15 percent per encounter
  2. Missed annual wellness visits (AWV) and G-code opportunities
  3. Chronic care management (CCM) 99490, 99491 billable time unbilled
  4. Transitional care management (TCM) 99495, 99496 left on the table
CPT specimen sheet

High-volume Primary Care codes we code and appeal

Not a complete list. A representative slice of the codes that drive revenue and denials for primary care practices.

CodeDescriptionProfile
99213Established patient E/M, low complexityHigh volume
99214Established patient E/M, moderate complexityModifier-sensitive
G0438Initial Medicare Annual Wellness VisitDenial-prone
G0439Subsequent Medicare AWVHigh volume
99490Chronic Care Management, 20 minutesModifier-sensitive
99495Transitional Care Management, moderate complexityDenial-prone
99497Advance Care Planning, 30 minutesHigh volume

How we run primary care billing

E/M leveling aligned to 2021 AMA guidelines. Monthly chart audit to flag undercoding patterns. Automated CCM and TCM tracking so eligible patients get billed for the time your team is already putting in.

Why it matters Primary Care practices win or lose on coding precision at the line-item level. Generalist billers average 8 to 12 percent revenue leakage on specialty-specific edge cases. Our coders run only specialty books, so the edge cases are the book.

What the common denials look like and how we fix them

Pattern we see. Preventive vs problem-focused visit confusion, missing modifier 25 when preventive and problem visits are billed together, and medical necessity issues on higher-level E/Ms without sufficient documentation.

How we fix it. Every denial is logged against its CARC/RARC code and routed to a coder who owns the appeal. We rebuild the claim with the documentation the payer is actually asking for, not a generic reconsideration letter. Recovery rate on appealable primary care denials averages above 60 percent.

Services for this specialty

Where to go next

Pick a thread and keep pulling. Every engagement starts with the piece that has the biggest revenue leak.

ServiceMedical BillingServiceMedical CodingServicePatient CollectionsServiceRevenue Cycle Management
How do you handle preventive plus problem visits?
We code both with modifier 25 on the E/M, documentation supporting the separately identifiable service. Most primary care practices underbill this combination because the workflow is confusing. We catch every eligible instance.
Can you bill chronic care management?
Yes. CCM (99490, 99491) and complex CCM (99487, 99489) billing including the time tracking workflow. Most practices leave $100 to $150 per eligible patient per month unbilled.
Do you handle Medicare wellness visits?
Yes. Initial AWV (G0438), subsequent AWV (G0439), IPPE (G0402), and ACP (99497) all coded and billed with required elements documented.
Can you handle value-based care billing (ACO, PCMH, CCM)?
Yes. CCM (99490, 99491), TCM (99495, 99496), PCM (99424, 99425), and RPM (99453, 99454, 99457) all tracked with the monthly time logs and care plan documentation required.
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See what primary care billing could actually look like.

A written 30-day diagnostic. Dollar figures against every finding. No obligation.

Request a free audit Call (973) 699-6689
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