Primary care providers see more patients, manage more chronic conditions, and navigate more payers than almost any other specialty. Your billing operation needs to match that pace without letting revenue fall through the cracks.
Primary care and family medicine practices deal with a broader range of services, codes, and payers than almost any specialty. Preventive visits, sick visits, chronic disease management, telehealth, AWVs, CCM, behavioral health integration — every one of these has its own coding rules. One size definitely does not fit all.
Since the 2021 E/M revisions, medical decision making and time-based billing have changed significantly. Getting the level right — not too low, not unsupported — is the core of accurate primary care billing.
When a preventive visit turns into a problem-focused encounter, the right billing approach requires separate codes with the correct modifier. Many practices miss this billing opportunity entirely.
Medicare's AWV codes (G0438/G0439) are separate from the traditional physical exam and have specific requirements. Billing them correctly — and distinguishing them from the Welcome to Medicare visit — adds meaningful revenue.
CCM codes allow ongoing monthly reimbursement for care coordination of patients with two or more chronic conditions. It's one of the most underutilized revenue streams in primary care.
Arizona's Medicaid program has specific documentation and authorization requirements for primary care services. We know what AHCCCS expects and help keep your claims clean.
Place of service codes, modifiers, and payer-specific telehealth policies continue to evolve. We keep current with the rules so your telehealth claims don't fall through the cracks.
| Code | Service | Notes |
|---|---|---|
| 99202–99215 | Office / Outpatient E/M Visits | New & established patients; time or MDM-based |
| 99381–99387 / 99391–99397 | Preventive Medicine Visits | New and established; age-specific; includes counseling |
| G0438 / G0439 | Medicare Annual Wellness Visit | Initial (G0438) and subsequent (G0439) AWV |
| G0402 | Welcome to Medicare Preventive Visit | One-time; within first 12 months of Part B enrollment |
| 99490 / 99491 | Chronic Care Management | Monthly; 2+ chronic conditions; 20 min minimum |
| 99424–99427 | Principal Care Management | Single high-risk chronic condition |
| 99211–99215 + modifier 25 | Same-Day Sick & Preventive Visit | Modifier 25 required when problem-focused E/M added to preventive |
| 99441–99443 | Telephone E/M Services | Time-based; payer coverage varies |
| 99453 / 99454 | Remote Physiologic Monitoring | Setup and device supply; 16+ days of data required |
New to practice or expanding your panel? We handle Medicare and Medicaid enrollment, CAQH setup, and commercial payer credentialing so you can start seeing patients without billing delays.
See our credentialing services →We're a local, family-owned company in Tucson. When you have a question or a problem, you talk to us directly — not a helpdesk in another state. That's not something a national billing company can offer.
We're right here in Tucson. We understand the payer landscape, the AHCCCS rules, and the challenges that Southern Arizona providers face. Let's talk about how we can help your practice run better.
Led by Alda Wong, AAPC Certified Professional Coder (CPC) and Certified Professional Biller (CPB) — the credentials that back up every claim we submit on your behalf.