Family medicine billing
Family medicine billing services
We handle billing for family medicine practices, from well visits and sick visits for every age to vaccines, in-office labs and Medicare wellness visits. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and pricing starts at 2.5% of collections.
- Preventive and problem visits on the same day (modifier 25)
- Medicare annual wellness visits and preventive services
- Vaccine, injection and CLIA-waived lab billing
Why family medicine billing is different
Many small services, every age group, every payer
Family medicine claims are high volume and low dollar. A practice may see a newborn, a teenager and a Medicare patient in the same hour, and each one has different coding and coverage rules.
Well visit plus sick visit
When a patient raises a new problem during a physical, you can bill the preventive visit and a problem-oriented E/M with modifier 25, if the extra work is documented. Patients may owe a copay for the problem part, so the front desk needs to know.
Medicare does not pay for “physicals”
Medicare covers the Welcome to Medicare visit (G0402) and annual wellness visits (G0438, G0439), not the routine preventive codes 99381–99397. Billing the wrong one leaves the patient with a bill they did not expect.
Age-based preventive codes
Preventive visit codes change with the patient’s age and whether they are new or established. The code has to match the date of birth on file.
Vaccines and injections
Each vaccine needs a product code and an administration code, and Medicare pays flu, pneumonia and hepatitis B vaccine administration with its own G-codes. Children’s vaccines may come from the Vaccines for Children program.
In-office labs
Rapid strep, urine dips, glucose and similar tests need a CLIA certificate on file with the payer and, for many payers, modifier QW on waived tests.
Chronic and transitional care
Chronic care management, transitional care after a hospital stay and the G2211 add-on for ongoing care each have time, consent and documentation rules that are easy to miss.
Common codes
Family medicine codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 99202–99215 | New and established patient office visits | Level supported by decision making or time; modifier 25 with same-day preventive or procedure |
| 99381–99397 | Preventive medicine visits by age, new and established | Age band matches date of birth; not billed to Medicare |
| G0402 / G0438 / G0439 | Medicare Welcome to Medicare visit and annual wellness visits | Eligibility dates and once-per-year limits |
| G2211 | Add-on for ongoing care of a single serious or complex condition | Payer acceptance and the rules for same-day modifier 25 services |
| 90471 / 90472, G0008 | Vaccine administration (commercial and Medicare flu) | Right admin code for the payer; product code on the same claim |
| 99490 / 99439 | Chronic care management, clinical staff time | Patient consent, care plan and monthly time documented |
| 99495 / 99496 | Transitional care management after discharge | Contact within 2 business days and face-to-face visit timing |
| 36415, 81002, 87880 | Venipuncture, urine dip, rapid strep test | CLIA certificate on file and modifier QW where the payer requires it |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Family medicine denials we stop before they happen
Family medicine denials are usually small, but they add up across hundreds of claims a month. We catch the patterns and fix them at the source.
- Routine preventive codes sent to Medicare instead of wellness visit codes
- Annual wellness visit billed before 12 months have passed
- Missing or unsupported modifier 25 on a same-day sick visit
- Preventive code that does not match the patient’s age
- Vaccine product billed without the administration code, or the reverse
- Lab tests denied for a missing CLIA number or QW modifier
- Chronic care management billed without documented consent or enough time
What we handle
Everything between the visit and the payment
- Insurance eligibility and benefits checks before visits
- Charge entry and coding review of E/M levels, preventive visits and add-on codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for physicians, NPs and PAs
- Patient statements and balance tracking
- Monthly reporting on collections, denials and A/R
Our billing team does not call your patients. Patient calls stay with your practice, or with an optional RevenueCTRL virtual assistant.
Pricing
Clear pricing for family medicine practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing.
Our core focus is behavioral health. We bill family medicine and other specialties with the same team, the same CPB-certified billers and the same service promises.
Common questions
Can we bill a physical and a sick visit on the same day?
Yes, when the patient has a problem that needs significant extra work beyond the preventive visit. We bill the preventive code and a problem-oriented E/M with modifier 25, and we check that the note supports the second service. Rules vary by payer; we check current policy.
How do you bill Medicare wellness visits?
We bill the Welcome to Medicare visit or the initial or subsequent annual wellness visit, not the routine preventive codes, which Medicare does not cover. We check the patient’s eligibility dates first so the visit is not denied as too soon.
Do you bill Vaccines for Children (VFC) doses?
Yes. For VFC vaccines you bill the administration, not the vaccine itself, and some state Medicaid programs want the product code listed at no charge or with a specific modifier. We follow the rules of your state and payer.
Can you bill chronic care management?
Yes. We bill CCM and transitional care management when the consent, care plan and time records are in the chart, and we flag months where the minimum time was not met so you do not bill a service you cannot support.
Which EHRs do you work in?
athenahealth, eClinicalWorks, AdvancedMD, Tebra (Kareo), DrChrono, Office Ally and others. We work inside the system you already use.
How much does family medicine billing cost?
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. We give you an exact quote after a free review of your claims.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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