Specialty
Primary Care Physician Medical Billing
Preventive visits, problem visits, and the modifier that decides whether you get paid for both.
What makes primary care physician billing different
Primary care billing looks simple and is not. Volume is high, individual claim values are low, and the margin lives almost entirely in whether same-day services get paid separately. Get modifier 25 wrong across a year of visits and the loss is quiet but substantial.
The other pressure is Medicare's parallel vocabulary. An Annual Wellness Visit is not a physical, a physical is not covered, and patients use both words interchangeably. Practices routinely deliver a covered service and bill an uncovered one, or the reverse.
Preventive plus problem on one visit
A problem-oriented E/M billed alongside a preventive visit needs modifier 25 and documentation that stands on its own. Payers audit this pairing heavily.
AWV versus routine physical
G0438 and G0439 are covered; 99381 to 99397 generally are not under Medicare. The distinction is the service delivered, not what the patient called it.
Chronic care and transitional care time
99490 and 99495 to 99496 require documented time and specific care-management elements. Most practices that qualify never bill them at all.
E/M level selection after 2021
Level can rest on medical decision-making alone or on total time. Practices still counting bullets systematically leave levels on the table.
Ask any billing company this
“Show me my modifier 25 denial rate for the last two quarters.”
A company that bills your specialty properly will answer this in one sentence. A company that treats every specialty the same will answer it with a brochure.A note on accuracy. Coding rules, coverage policies and payer edits change continually, and the specifics above reflect general practice rather than any individual payer contract or local coverage determination. Treat this page as a map of where to look, not as coding advice for a particular claim.