Overview
Most primary care practices are leaving money on the table — not on the visits they bill, but on the services they perform and never charge for. Chronic care management, transitional care, annual wellness visits, and remote monitoring are all billable and all routinely missed. We capture them.
Why these claims get denied
The denial reasons we see most often in primary care — and what our pre-billing checks are built to catch.
- Preventive and problem-focused visits on the same day without modifier 25
- Annual wellness visit billed when the initial IPPE was never done
- CCM billed without documented consent or the required time threshold
- Screening versus diagnostic diagnosis codes mismatched to the service
- Medicare frequency limits exceeded on preventive services
- Incident-to requirements not met for services rendered by staff
A real claim from this specialty
The kind of claim we see every week in primary care, and the denial that usually follows it.
Sample claim · single date of servicePrimary Care
99214 25Office visit, established patient$186.00
G0439Annual wellness visit, subsequent$138.00
36415Venipuncture$9.00
Denied — problem visit bundled into preventive
How we resolved itClassic modifier 25 denial. The note clearly supported a separate problem-focused visit; appealed and both services paid.
What we do for your practice
- Missed-revenue audit — we find the CCM, TCM, and AWV opportunities already in your charts
- Correct modifier 25 usage so same-day preventive and problem visits both pay
- Frequency tracking against Medicare's preventive service calendar
- Documentation review that supports the E/M level actually billed
- Chronic care management time logging and consent workflows
- Quality program reporting alignment so incentives aren't forfeited
Codes and rules that matter here99202–99215 E/M, G0402/G0438/G0439 wellness visits, 99490/99439 chronic care management, 99495/99496 transitional care, 99453/99454/99457 remote monitoring.
Common questions
Can a wellness visit and a problem visit be billed the same day?
Yes, when the problem-focused service is significant and separately documented. The E/M needs modifier 25 and the note must clearly separate the preventive work from the problem work. Without that separation, the E/M gets bundled.
What revenue do primary care practices most often miss?
Chronic care management (99490), transitional care (99495/99496), and remote monitoring. These are services most practices already perform but never bill because the time logging and consent workflow was never set up.
How often can Medicare wellness visits be billed?
The IPPE is once in a lifetime within the first 12 months of Part B enrollment; the annual wellness visit follows and can be billed once every 12 months thereafter. Billing an AWV before the IPPE window closes is a routine denial.