Specialty billing
Primary Care billing
We code primary care to your payer rules, not a generic template, so preventive, problem-based, and care-management work all get billed the way each plan expects.
Where claims slip
Billing considerations for primary care
Common places primary care revenue leaks. We code each of these to your payer rules, not a one-size-fits-all template.
Preventive versus problem-based visits coded together need clear documentation and the right modifier, or one half gets denied.
Modifier 25 on a same-day E&M with a procedure is a common audit trigger when it is over- or under-used.
Annual Wellness Visits (G0438/G0439) follow Medicare rules that differ from a routine preventive exam.
Chronic Care Management and Transition Care Management are time-based and require specific documentation to bill cleanly.
Payer-specific preventive bundling rules change which screenings are separately billable.
Representative codes
Codes we see in primary care
A few illustrative CPT and HCPCS examples, not an exhaustive or guaranteed list. We code from your documentation and each payer's current rules.
- 99202-99215
- Office / outpatient E&M, new and established patients
- 99381-99397
- Preventive medicine visits, age-based
- 99490
- Chronic Care Management, clinical staff time
- 99495-99496
- Transition Care Management services
- G0438 / G0439
- Initial and subsequent Annual Wellness Visit (Medicare)
Illustrative examples for context only. Actual codes depend on documentation, setting, and payer rules, and code sets change over time.
How we help
How our services apply to primary care
The same accountable team handles the work behind your primary care claims. Here is where each service fits.
Common questions
Primary Care billing, answered.
Can you handle both preventive and problem-based visits on the same day?
Yes. We code the preventive service and the separately identifiable problem visit to each payer's rules, with the appropriate modifier and documentation, rather than defaulting to one or the other.
Do you set up Chronic Care Management billing?
We can bill CCM and Transition Care Management where your documentation and time tracking support it. We code what the chart supports, not a flat assumption, since these are time-based services.
How do you reduce denials on modifier 25?
We apply modifier 25 only when the visit is separately identifiable and documented, and we flag charts that do not support it before they go out. That keeps clean claims up without inviting audit risk.
Ready to bill primary care the right way?
732-209-1487 · info@vertexmedicalbilling.com