Primary Care billing
Primary care is paid for volume and increasingly for care between visits. Most practices bill the visits well and never bill the programs — chronic care management, transitional care and remote monitoring are documented in the chart and absent from the claim.
What actually gets denied
An annual wellness visit and a separately identifiable problem visit are both billable with modifier 25 and distinct documentation. Practices that avoid it lose real revenue; practices that do it reflexively invite review.
The annual wellness visit is a distinct benefit with required elements, not a routine physical, and confusing them produces patient-liability disputes.
CCM requires documented consent, a care plan and tracked clinical staff time per calendar month, with strict rules against duplicate billing across providers.
The vaccine product and its administration are separate lines, and counts follow components, not injections.
Payer behavior
Quality measure codes and risk-adjustment diagnoses affect payment outside the claim's own allowable.
TCM requires contact within two business days and a face-to-face visit inside a defined window from discharge.
Plan-level policy differences mean 'Medicare rules' are not a single rulebook.
Documentation traps
Problems addressed, data reviewed and risk should be visible in the note.
Minutes per calendar month must be recorded contemporaneously.
Diagnoses must be assessed and documented each year to be valid.
Every primary care account is staffed by coders who bill this specialty daily. The work spans our full medical billing and revenue cycle management services — coding, claim scrubbing, denial management and A/R recovery — and you can see how engagements are structured on our pricing page. For the full specialty bench, go back to all specialties we bill, or contact us at (555) 555-0142.
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