Routine exam not covered by Medicare
Medicare does not cover preventive physical codes; it covers the AWV and specific screenings.
How we prevent it: We bill Medicare patients with AWV and preventive G-codes.
PRIMARY CARE BILLING
Primary Care Billing Services
Primary care practices bill high volumes of E/M visits, preventive services, vaccines and care management programs.
No upfront feesHIPAA-compliantSpecialty-trained coders
$0
Upfront or setup fees
0
Revenue cycle steps managed end to end
0
Specialties and lab types we bill for
0
Of your data and systems stay yours
OVERVIEW
Primary Care billing done right
Primary care practices bill high volumes of E/M visits, so small coding gaps add up quickly. Under-coded visits, missed add-ons and preventive services billed wrong reduce revenue on every day of the year.
Primary care also includes preventive visits for all ages, Medicare annual wellness visits, screenings, vaccines, care management and behavioral health integration, each with its own rules on frequency and cost sharing.
We help primary care practices capture every service they provide, code preventive and problem-oriented care correctly and keep patients from getting surprise bills for preventive services.
Also see our medical coding, denial management, eligibility verification and revenue cycle management services.
CODING
Common primary care CPT & HCPCS codes we bill
Primary care revenue depends on capturing preventive, screening and care management services alongside visits.
| Code | Description | What we watch for |
|---|---|---|
| 99395 | Preventive visit, established patient, age 18–39 | Commercial preventive code; problem visits are billed separately with modifier 25. |
| 99396 | Preventive visit, established patient, age 40–64 | Preventive codes are chosen by age and new or established status. |
| G0438 | Annual wellness visit, initial | Once per lifetime, at least 12 months after Part B enrollment. |
| 96160 | Patient-focused health risk assessment instrument | Billed with the AWV or preventive visit where payers allow. |
| G0444 | Annual depression screening, 5–15 minutes (Medicare) | Once per year; not with the initial AWV. |
| G0442 | Annual alcohol misuse screening, 5–15 minutes | Once per year for Medicare patients. |
| 99484 | Care management for behavioral health conditions, 20 minutes per month | Requires an ongoing care plan and clinical staff time. |
| 99406 | Smoking and tobacco cessation counseling, 3–10 minutes | Time must be documented. |
| 90471 | Immunization administration, first vaccine | Bill each vaccine product separately. |
| 99213 | Established patient office visit, low complexity | Level must match MDM or time. |
Code descriptions are summarized. CPT® is a registered trademark of the American Medical Association. Coverage and payment rules vary by payer and change every year; we code to the current code set and your payers’ policies.
Modifiers that matter in primary care billing
25
Significant, separate E/MFor a problem visit on the same day as a preventive visit.
33
Preventive serviceShows commercial plans that cost sharing should be waived.
95
Synchronous telehealthFor audio-video visits where payers require it.
GT
Telehealth (some payers)Still required by some payers for telehealth services.
DENIALS
Why primary care claims get denied
The denial reasons we see most often in primary care billing, with the claim adjustment reason code (CARC) payers usually attach, and what we do so they don't happen again.
Preventive service frequency exceeded
Wellness visits and annual screenings have once-per-year limits.
How we prevent it: We check last service dates before scheduling.
Problem visit bundled with preventive care
A problem visit without separate documentation and modifier 25 is bundled.
How we prevent it: We bill both when documented and apply modifier 25.
Patient charged for preventive care
Without preventive modifiers or diagnoses, patients get cost sharing for preventive services.
How we prevent it: We sequence preventive diagnoses and modifiers so benefits apply.
Add-on without a qualifying service
Add-on codes need their primary service on the same claim.
How we prevent it: Our edits pair add-ons with primary codes.
HOW WE WORK
How we run your primary care revenue cycle
From the first eligibility check to the final patient payment, one dedicated team handles every step and reports back to you.
01
Eligibility and authorization
We verify coverage, benefits, copays and deductibles before the visit. For primary care, that includes checking preventive eligibility dates.
02
Charge capture and coding
Our coders review documentation and assign CPT, HCPCS and ICD-10-CM codes to the highest supported specificity. Visits are coded from MDM or time, with preventive services and add-ons captured.
03
Claim scrubbing and submission
Every claim is checked against NCCI edits, payer policies and modifier rules before it goes out electronically, so it is paid on the first pass.
04
Payment posting and reconciliation
We post ERAs and EOBs, compare payments to your contracted rates and flag underpayments for appeal.
05
Denial management and A/R follow-up
Every denial is worked: corrected, appealed or escalated, with root causes fed back to the front end. Preventive and frequency denials are corrected and rebilled with the right codes.
06
Reporting and patient billing
You get clear monthly reports on collections, denials and A/R aging, and patients get easy-to-read statements and answers to billing questions.
COMPLIANCE
Primary Care payer rules we track for you
Rules that change how primary care claims must be coded, documented and submitted.
Preventive and problem visits: can both be billed on the same day when the problem visit is separately documented.
Medicare preventive services: use specific G-codes with frequency limits.
ACA preventive services: many are covered without cost sharing on commercial plans.
Behavioral health integration: care management codes need a care plan and monthly time tracking.
FAQ
Primary Care billing questions
Do you help capture preventive revenue?
Yes. We bill AWVs, screenings and counseling services that are often missed, and track eligibility dates.
How do you code preventive and sick visits on the same day?
We bill the preventive code and the problem visit with modifier 25 when the note shows separate work.
Do you bill care management?
Yes. We bill CCM, behavioral health integration and RPM with time and consent tracking.
How much do your primary care billing services cost?
We charge a percentage of what we actually collect for you, with no upfront or setup fees. Your rate depends on claim volume and the services you need, so we quote it after a free review of your current billing.
Do we have to change our EHR or practice management system?
No. We work inside the systems you already use, and your data stays yours. We set up secure access, learn your workflows and start working claims without disrupting your front desk.
Related specialties
FREE PRIMARY CARE BILLING REVIEW
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