Family Medicine Billing Specialists
Primary care physicians lose 15–25% of billable revenue annually to missed CCM codes, underdocumented Annual Wellness Visits, and Modifier 25 errors. Healix RCM captures every dollar your practice earns — without adding a single patient to your schedule.
Turn Administrative Burden into Predictable Revenue
Family medicine has evolved far beyond the 15-minute appointment. Modern payers want to reimburse you for keeping your panel healthy — through Chronic Care Management, Transitional Care, and remote monitoring. But only when you use the right codes with the right documentation.
Most primary care practices are leaving $75,000–$150,000 per provider on the table every year because their generalist billing team doesn't know what CCM-eligible looks like, or doesn't have a workflow to alert staff before a TCM window expires.
- We identify every CCM-eligible patient in your panel automatically.
- We scrub claims for missed depression screens (G0444) and social determinant codes (Z-codes).
- We alert your staff before AWV windows and TCM deadlines expire.
- We audit every skin procedure to ensure supply J-codes are included.
- We track your E/M distribution and compare it to national benchmarks monthly.
Common Revenue Leak Points
1Modifier 25 Misuse
Billing a sick visit (99213/4) on the same day as a physical (99391–99397) is a top audit trigger. We ensure documentation clearly separates the 'significant, separately identifiable service' so you confidently bill both and get paid for both.
2Missed Care Management Revenue
Family physicians coordinate care daily but rarely bill for it. We implement Chronic Care Management (99490) and Principal Care Management (G2064) workflows. This often adds $50,000+ per provider annually — without seeing a single extra patient.
3Vaccine Administration Errors
You paid for the vaccine; you should get paid for administering it. We track every dose, ensure counseling codes (90460) are used for patients under 18, and correctly stack administration codes (90471/90472) for adults receiving multiple vaccines.
4Annual Wellness Visit (AWV) Gaps
Medicare pays 100% for AWVs (G0438/G0439), yet fewer than 20% of eligible seniors receive them. We provide pre-visit checklists to your front desk, ensuring the Health Risk Assessment is completed and the visit is billing-ready before the patient walks in.
Three High-Value Codes Most Practices Never Bill
These revenue opportunities exist in virtually every family medicine practice. They require no new patients, no new equipment — just the right billing workflow.
Chronic Care Management (CCM)
CPT 99490 / 99491 / G2064
Family physicians manage an average of 40–60 CCM-eligible patients. At $62 per patient per month (Medicare rate), this represents $50K–$75K in untapped annual revenue from care coordination work your team is already performing.
Annual Wellness Visits (AWV)
G0402 / G0438 / G0439
Fewer than 20% of Medicare-eligible seniors receive their Annual Wellness Visit. We proactively identify eligible patients, provide HRA documentation checklists, and ensure every AWV is completed correctly — reimbursed at 100% with zero patient co-pay.
Transitional Care Management
CPT 99495 / 99496
TCM codes are among the highest-value codes in primary care, yet they require a contact attempt within 2 business days of discharge. We alert your staff the moment a patient is discharged, turning a 2-minute phone call into $200+ in same-week revenue.
Principal Care Management (PCM)
CPT 99424 / 99425 / G2064
PCM is CCM's sibling for single high-complexity chronic conditions — COPD, CHF, diabetes with complications. A patient managing one serious condition qualifies for PCM even if CCM isn't appropriate. At 30 minutes monthly, PCM adds $70–$120 per patient with near-zero overhead.
Full-Spectrum Primary Care RCM
From the newborn nursery to the nursing home, we support every setting where family physicians practice — handling the complete revenue cycle so you can focus on patient care.
Preventive Care Optimization
We navigate the complex overlap between commercial 'physicals' and Medicare 'Wellness Visits,' preventing G0438/99397 mix-ups that cause patient balance disputes and payer denials. Every preventive visit is coded to its highest accurate level.
CCM & Care Management Programs
We build and manage Chronic Care Management workflows from the ground up — identifying eligible patients, tracking the 20-minute monthly threshold, documenting care plans, and submitting G2064/99490 claims so you capture every dollar of this high-value stream.
Telehealth & Remote Patient Monitoring
We manage RPM billing (99454/99457), ensuring the 16-day data transmission requirement is documented before claim submission. Telehealth claims are submitted with the correct POS codes (02 vs. 10) and modifiers to maximize reimbursement wherever parity laws apply.
E/M Level Optimization
Many family physicians undercode 99213 when their documentation clearly supports 99214. We audit your E/M distribution monthly, compare it against specialty benchmarks, and pinpoint fear-based downcoding — protecting your revenue without increasing audit risk.
Pediatric-to-Geriatric Continuity
We manage the full age spectrum — tracking the 3-year new patient rule, age-appropriate preventive codes (99381–99397), EPSDT requirements for Medicaid children, and SNF/nursing home care management eligibility across your entire patient panel.
Minor Procedures & Injections
Family physicians handle skin tags, joint injections, and lacerations every day. We ensure you capture both the procedure code (e.g., 20610 for large-joint injection) and the drug supply J-code — revenue that's routinely forgotten and never billed.
How We Unlock Your Revenue in 30 Days
Our structured onboarding process is designed to identify and recover revenue quickly — most practices see measurable improvement within the first billing cycle.
Practice Onboarding & EHR Access
We integrate with your existing EHR within 5 business days — no workflow disruption, no data migration. We access the billing module and immediately run a baseline revenue audit to quantify what's been left on the table.
Revenue Opportunity Audit
We run a 90-day lookback on your claims, identifying missed CCM patients, undercoded E/M visits, and unfiled AWVs. You see the exact dollar amount we can recover before we submit a single new claim on your behalf.
Clean Claim Submission
Every claim is scrubbed against payer-specific edits, NCCI bundles, LCD requirements, and your individual payer contracts before submission. Our 98.7% first-pass rate means faster cash flow and far less AR aging.
Denial Management & Monthly Reporting
Denied claims are worked within 48 hours. Monthly reporting gives you a clear view of your collection rate, denial trends, and E/M distribution — so you always know exactly where your revenue stands and what's improving.
We Already Know Your EHR
You shouldn't have to teach your billing team how to use your software. We operate fluently inside your existing system on day one — whether that means pulling CCM time logs from athenahealth or reading hidden tabs in Epic.
Family Medicine Billing FAQs
Real answers to the billing questions we hear most from primary care physicians.
QCan I bill for reviewing labs after hours?
Generally, no — reviewing labs is bundled into the E/M code. However, if you spend 20+ minutes coordinating care or discussing results with a caregiver or specialist, you may qualify for Prolonged Services (G2212) or Chronic Care Management codes. We identify and capture these time-based billing opportunities that most practices miss entirely.
QWhat is the difference between G0402 and G0438?
G0402 is the 'Welcome to Medicare' preventive visit (once per lifetime, within the first 12 months of Medicare eligibility). G0438 is the 'Initial Annual Wellness Visit' (once per lifetime, after the first 12-month window closes). G0439 is the 'Subsequent AWV' billed annually after that. Mixing these up causes immediate denials. We track each patient's AWV history so you always submit the correct code.
QDo you handle Transitional Care Management (TCM)?
Yes — TCM (99495/99496) is one of the highest-value codes in primary care, but it requires a contact attempt within 2 business days of hospital discharge. We alert your staff the moment we receive a discharge notification, so you can make that billable call before the window closes. This single workflow addition routinely adds thousands of dollars in monthly revenue for busy primary care practices.
QHow do you handle 'Nurse Visit' billing?
Nurse visits (99211) are valid for weight checks, blood pressure monitoring, or PPD reads, but they must meet 'incident-to' supervision requirements — the supervising physician must be present in the office suite when care is delivered. We audit these claims for compliance and ensure you are not inadvertently submitting non-compliant incident-to claims that could escalate into a full compliance review.
QWhat is Principal Care Management (PCM) and how is it different from CCM?
Principal Care Management (PCM — CPT 99424/99425) is designed for patients with a single complex chronic condition, such as moderate-to-severe COPD, advanced CHF, or poorly controlled diabetes with complications. Unlike CCM (which requires two or more chronic conditions), PCM focuses intensively on one condition. A patient can qualify for PCM or CCM but not both simultaneously. We assess your entire panel and assign the correct program to each eligible patient to maximize monthly recurring revenue.
QCan we bill an Annual Wellness Visit and a sick visit on the same day?
Yes — billing both is allowed, but it's one of the most commonly denied combinations without the right documentation. You must append Modifier 25 to the E/M code (not the AWV code) and document that the sick or problem-focused visit was a 'significant, separately identifiable' service beyond the standard AWV elements. We provide documentation templates and pre-submission audits that ensure every same-day AWV + E/M combination is billed correctly and supported.
QHow does Remote Patient Monitoring (RPM) billing work for primary care?
RPM (CPT 99453–99458) reimburses you for physiologic monitoring devices — blood pressure cuffs, pulse oximeters, glucometers, weight scales — that transmit data from home. The setup code (99453) is billed once. The supply/device code (99454) is billed monthly when the patient transmits data for ≥16 days. Care management (99457) is billed monthly for ≥20 minutes of staff time reviewing data and communicating with the patient. We track device data transmission compliance so you never submit a 99454 on a patient who only transmitted 9 days — a common audit trigger.
QWhat's the difference between a Medicare Annual Wellness Visit and a commercial preventive exam?
Medicare Annual Wellness Visits (G0438/G0439) are not physical exams — they include a Health Risk Assessment, personalized prevention plan, cognitive screening, and depression screening, but do NOT include a hands-on physical examination. A commercial 'physical' (99381–99397) is a traditional head-to-toe exam. Billing a preventive exam code for a Medicare patient who received only an AWV — or vice versa — is one of the most common billing errors in primary care. We ensure the correct code is used based on what was actually documented and performed.
Ready to stop leaving money on the table?
Get a free audit of your E/M distribution and CCM eligibility. We'll show you exactly how much revenue your practice is currently missing — with no obligation to sign.