Specialty billing
Primary Care Billing Services
Primary care runs on high visit volume and a lot of small details. A single day can include preventive and problem visits, wellness exams, care management time and vaccines, and each of these has its own rules.
Rules to watch
- Modifier 25 documentation on same-day services
- Frequency limits on preventive services
- G2211 visit complexity add-on eligibility for Medicare
- Care management consent and time tracking
- Eligibility checks for high-volume scheduling
How does primary care billing work?
Primary care billing turns a high volume of short visits into clean claims, and most of the money is in the details. A typical day mixes problem visits coded by E/M level, age-based preventive visits, Medicare annual wellness visits, vaccines and care management time. Several of these can land on the same date, so modifier 25, frequency limits and documentation decide what gets paid. Internal medicine practices see more chronic care management and Medicare G-codes; family medicine adds more pediatric preventive care and vaccines. Either way, the usual leaks look alike: a wellness visit billed as a physical, care management minutes that were never captured, and a same-day sick visit left off the claim because nobody added the modifier.
What makes it different
What makes primary care billing different
Codes at a glance
Common primary care codes and what to watch
| Service | Codes | What to watch |
|---|---|---|
| Office visits | 99202–99205 (new), 99211–99215 (established) | Level set by medical decision making or total time |
| Preventive visits | 99381–99387, 99391–99397 | Coded by age; a separate problem visit needs modifier 25 |
| Medicare wellness visit | G0438 (initial), G0439 (subsequent) | Not the same service as a routine physical |
| Chronic care management | 99490 (first 20 minutes) | Patient consent and time tracking required |
| Visit complexity add-on | G2211 | Medicare; ongoing care relationship documented |
Related services
Services that matter most for primary care
FAQ
Primary Care billing questions
Can a preventive visit and a sick visit be billed on the same day?
Often, yes, as long as a significant, separately identifiable problem is addressed and documented. The problem-oriented E/M is typically reported with modifier 25. Payer policies vary, so documentation matters.
What is the difference between an annual wellness visit and a physical?
A Medicare annual wellness visit focuses on a personalized prevention plan and health risk assessment and does not include a comprehensive physical exam. A routine physical is a different service with different coverage rules.
How do I choose between 99213 and 99214?
It depends on the level of medical decision making or the total time on the date of the visit: low MDM or 20 minutes or more supports 99213, and moderate MDM or 30 minutes or more supports 99214. Our 99213 vs. 99214 guide walks through it.
Coding rules change every year. The code references on this page reflect general guidance at the time of writing. Payer policies and your documentation always determine what is billable.
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