Wellness visits, same-day problem visits, care management, vaccines and telehealth billed to each payer's rules, with front-desk assistants, patient marketing and a claims portal for family medicine practices.
Quick answer
Family practice billing services handle the claims a family medicine office creates every day: preventive and problem visits on the same date, Medicare wellness visits, the G2211 add-on, chronic and transitional care management, and vaccines billed to Part B or Part D. RCM Finder pairs that billing with front-desk assistants, patient marketing and a claims portal.
Family practice billing is different because one office bills every age group, almost every payer and several kinds of care on the same day. One visit can combine a preventive exam, a new problem, a vaccine and care management, and each part follows its own rule.
Adult-only practices should see our internal medicine billing page, and children-only practices our pediatric billing page.
Preventive rules split by payer. Medicare does not cover a routine physical, per CMS. It pays for an Initial Preventive Physical Exam (IPPE) in the first 12 months of Part B, then Annual Wellness Visits (AWVs), at no cost to the patient under assignment. Under 45 CFR 147.130, commercial plans must cover USPSTF A and B services, ACIP-recommended vaccines and HRSA-supported guidelines without cost sharing, though grandfathered plans are exempt.
CMS's CY 2026 fee schedule final rule fact sheet (October 31, 2025) raised the conversion factor to $33.40 for clinicians who are not qualifying APM participants, from $32.35. A new -2.5% efficiency adjustment to work RVUs spares time-based services, such as E/M visits, care management and behavioral health.
A family practice needs patients finding you, a front desk that checks benefits and wellness timing, billing that separates preventive and problem work, and software that shows every claim.
Revenue leaks at the handoffs, such as care management billed with no consent on file. We run all four pillars against one set of payer rules.
Our healthcare digital marketing helps local families and new Medicare patients find you through local SEO, Google Ads and reviews, with tracking set up to follow HHS guidance.
Our virtual medical assistants for family practices work on your time zone. They verify eligibility, check IPPE and AWV timing, sort vaccines by Medicare part and confirm care management consent is on file.
Our end-to-end family practice revenue cycle management covers coding, claim scrubbing, denials and A/R follow-up, with extra checks for modifier 25, G2211, wellness frequency and care management overlaps.
Our practice management system tracks every claim by stage, applies specialty-aware billing logic per claim, checks data completeness before submission and flags underpayments.
Find where your family practice claims leak
We review recent claims, denials and front-desk workflow, then show where wellness, modifier 25 or care management rules cost you.
Each service line has its own frequency, consent or same-day rule. Codes are examples in our own words (the AMA owns CPT descriptors); check current code sets before billing.
| Service line | Code examples (our wording) | Rule to follow | Typical denial trigger |
|---|---|---|---|
| Preventive plus problem visit (commercial) | 99381–99387 (new); 99391–99397 (established); 99202–99215 with modifier 25 | Problem visit only if it needed significant extra work, with its own note; cost sharing may apply to it | Modifier 25 on a minor problem handled in the exam |
| Medicare IPPE and AWV | G0402 (IPPE); G0438 (first AWV, once per lifetime); G0439 (later AWVs); 99497-33 (advance care planning) | IPPE within 12 months of Part B; AWV 12 months after the last IPPE or AWV; never both on one day | IPPE after the window; repeat G0438; missing AWV elements |
| Visit complexity add-on | G2211 with 99202–99215; from 2026, home visits | Continuing focal point of care, or ongoing care for one serious condition | Modifier 25 visit paired with a service other than an AWV, vaccine administration or allowed preventive service |
| Chronic and principal care management | 99490, 99439, 99491, 99437, 99487, 99489 (CCM); 99424–99427 (PCM) | Two or more chronic conditions (CCM); documented consent; one practitioner a month | No consent; complex and non-complex CCM in one month |
| Advanced Primary Care Management | G0556; G0557 (two or more chronic conditions); G0558 (plus QMB status) | Monthly bundle, no time threshold; consent once; one provider a month | Two providers in one month; G0558 without QMB status |
| Transitional care management | 99495 (visit within 14 days); 99496 (within 7 days) | Contact within 2 business days; one practitioner per 30 days | Late contact or visit; visit on the day of discharge management |
| Behavioral health integration | 99484 (general BHI); 99492–99494 (collaborative care); G0568–G0570 (with APCM) | Consent and an initiating visit; cost sharing applies | General BHI and collaborative care in one month |
| Vaccines | G0008 (flu), G0009 (pneumococcal), G0010 (hepatitis B), 90480 (COVID-19); shingles, RSV, Tdap go to Part D | Part B preventive vaccines have no cost sharing; Part D vaccines bill the Part D plan | Part D shot billed to Part B; office visit for a vaccine-only encounter |
Sources: AAFP; 45 CFR 147.130; Noridian (2026); 42 CFR 410.15; CMS MM13473 (2025), MLN006559 (2026), MLN909188 (2025), MLN908628 (2025), MLN909432 (2026), MLN908764 (2026); CMS APCM page (2026); Claims Processing Manual ch. 18 (2026); AAPC. Rules vary by contractor and payer.
The American Academy of Family Physicians advises billing the problem visit with modifier 25 only when the problem needed significant extra work, documenting its medical necessity and making each service supportable on its own. A trivial problem is not billed separately.
Under 45 CFR 147.130, a plan may charge cost sharing for a separately billed office visit; the preventive service stays free. Noridian, one Medicare contractor, allows a medically necessary E/M with an IPPE using modifier 25, bars an IPPE and AWV together, and says to bill an E/M if a required AWV element under 42 CFR 410.15 is missing. Advance care planning with modifier 33 on the AWV claim has no cost sharing. Other MACs may differ. See our modifier 25 and 59 explainer.
MLN Matters MM13473 ties G2211 to practitioners who are the patient's continuing focal point for care, or who give ongoing care for one serious or complex condition; its example is a primary care patient with sinus congestion. Since 2025 it pays on a modifier 25 visit only alongside an AWV, vaccine administration or Part B preventive service, though the preventive services chart excludes glaucoma screening. The STFM handbook says G2211 does not fit a one-time visit with no ongoing care.
CMS's Part D vaccines booklet (July 2026) puts flu, pneumococcal, COVID-19 and risk-based hepatitis B shots under Part B, and others, such as shingles, RSV and Tdap, under Part D. Part B administration codes come from chapter 18 of the claims manual and CMS's vaccine pricing page. For a Part D shot, an out-of-network prescriber can bill the plan by portal or standard claim and accept its payment in full, or the patient can use an in-network pharmacy. Chapter 18 also bars a routine office visit charge for a vaccine-only encounter. See our RSV vaccine coding guide.
Care management codes pay for work between visits; billing depends on consent, timing and avoiding overlaps.
CMS's CCM booklet (June 2025) requires two or more chronic conditions expected to last at least 12 months, documented verbal or written consent, and an initiating visit for new patients and those not seen within the past year. One practitioner bills per month. CCM can run during a TCM period, with RPM or RTM but not both. Our CCM coding guide goes deeper.
APCM, available since January 1, 2025, lets the practice responsible for a patient's primary care bill one monthly bundle in place of separate care management services, with no time threshold. Consent is collected once. An initiating visit is needed unless the practice saw the patient within 3 years or gave another care management service within a year.
Under CMS MLN908628 (August 2025), the TCM period runs 30 days from discharge. Clinical staff must make interactive contact within 2 business days, and the visit, which can be by telehealth, must follow within 14 days (99495) or 7 days (99496). Only one practitioner can bill the period.
The CMS BHI booklet (January 2026) describes 99484 as at least 20 minutes of clinical staff time a month. In the Collaborative Care Model, 99492, 99493 and 99494 cover the first 70 minutes, the first 60 minutes and each extra 30 minutes of care manager time. An AWV, IPPE, comprehensive E/M or TCM visit can start the service, and since 2026, G0568–G0570 add it to APCM. See our behavioral and mental health RCM page.
Several common family practice denials start before the visit: a wellness code that does not fit the patient's history, a vaccine sent to the wrong benefit, or missing consent.
Since January 1, 2026, the CMS-0057-F rule has required Medicare Advantage, Medicaid and CHIP plans to decide expedited requests within 72 hours and standard requests within seven calendar days; drugs are excluded. In the AMA's 2025 survey of 1,000 physicians, released in May 2026, physicians averaged 40 prior authorizations and 13 hours of physician and staff time a week.
| Check | Rule | Source | What the VMA does |
|---|---|---|---|
| Medicare patient wants a physical | Not covered; IPPE in the first 12 months of Part B, then AWVs | CMS (2026); Noridian (2026) | Books the right wellness visit |
| Last wellness visit | No IPPE or AWV in the past 12 months; G0438 once per lifetime | 42 CFR 410.15; Noridian (2026) | Confirms the last date, including other offices |
| Commercial preventive benefit | Covered preventive care is free; a separate problem visit may not be | 45 CFR 147.130 | Checks the benefit; warns of a possible copay |
| Vaccines due | Part B: flu, pneumococcal, COVID-19, hepatitis B. Part D: the rest | CMS MLN908764 (2026) | Sorts each shot; confirms the Part D billing path |
| Care management | Consent documented; initiating visit when required | CMS MLN909188 (2025); APCM page (2026) | Confirms both are on file |
| Hospital discharge | Contact within 2 business days; visit within 7 or 14 days | CMS MLN908628 (2025) | Logs it, alerts clinical staff, books the visit |
| Prior authorization | MA, Medicaid, CHIP: 72 hours expedited, 7 days standard; drugs excluded | CMS-0057-F (2024) | Logs due dates; follows up; saves denial reasons |
| Telehealth visit | Flexibilities through Dec 31, 2027; POS 10 at home, 02 elsewhere | HHS (2026); CMS FAQ (2026) | Records the patient's location |
Sources: CMS wellness visit page (2026); Noridian (2026); 42 CFR 410.15; 45 CFR 147.130; CMS MLN908764 (2026), MLN909188 (2025), MLN908628 (2025); CMS APCM page (2026); CMS-0057-F fact sheet (2024); HHS telehealth page (2026); CMS Telehealth FAQ (2026). Always check the patient's current plan.
HHS (February 2026) and CMS's telehealth FAQ (February 2026) say Medicare's broader telehealth flexibilities, including home visits without geographic limits and audio-only care, run through December 31, 2027. The FAQ adds that from January 1, 2028, patients generally must be in a medical facility in a rural area for telehealth other than behavioral health. See our telehealth billing guide and prior authorization guide.
See what denials and slow A/R cost you
Enter your visit volume and denial rate to estimate what your family practice is losing.
Family practice growth depends on local search, reviews and easy booking, and the tracking behind it must follow HIPAA.
We build location pages, a Google Business Profile per office and pages for wellness, chronic care and sick visits. We ask real patients for reviews, never confirm a patient relationship in replies, and invite Medicare patients to a wellness visit, not a free physical.
HHS tracking guidance says tracking on portals, appointment pages and symptom checkers can collect protected health information, and a cookie banner is not a HIPAA authorization. A 2024 court order vacated part of that guidance; we still keep tracking off booking pages without a vendor BAA.
Stay in-house if you have experienced coders and front-desk time for wellness checks. Use a billing-only vendor if claims are your only gap. Choose a combined partner when problems start at the front desk.
| Job | In-house team | Billing-only vendor | Four-pillar partner (RCM Finder) |
|---|---|---|---|
| Wellness-visit timing and benefits | Front desk, between calls | Varies; ask what is included | VMA checks dates and benefits before booking |
| Same-day preventive and problem visits | Each provider's habits | Ask how it is checked before submission | Modifier 25 and G2211 checked before submission |
| Monthly care management | Done when staff have time | Ask how time and consent are documented | Consent and discharges tracked; overlaps checked monthly |
| Vaccines (Part B or Part D) | Split across staff | Depends on the contract | Sorted before the visit |
| New-patient growth and reviews | A separate agency, or nobody | Not included | Marketing measured by booked new patients |
| Cost structure | Salaries, benefits, turnover | Varies; ask how fees are set | Quoted after a free practice audit |
The audit shows if you need only one pillar. Our revenue cycle management services and virtual medical assistant services can be contracted separately.
We start with a free audit and change nothing until you see the findings. We build our billing pipeline around how claims actually move through a practice: registration, charge entry, submission, payment and follow-up. For family practice, we add the checks on this page.
We review recent claims, denials and booking patterns, from wellness visits to vaccines.
We put a Business Associate Agreement in place before accessing patient data, then work inside your existing EHR (for example PrognoCIS, eClinicalWorks or athenahealth).
Your Medicare contractor's guidance and plans' preventive benefits become a pre-visit checklist and portal rules.
VMAs run pre-visit checks; claims are scrubbed, submitted and worked through denials and A/R.
We review denials by reason, A/R days, wellness visits due, care management enrollment and new patients.
Talk to us about your family practice
Tell us your payer mix and where claims stall. We will tell you honestly whether we fit.
Any billing vendor that handles your patients' data is a HIPAA business associate. Get a Business Associate Agreement before any access, and check how they limit and log it.
HHS guidance names billing, claims processing and practice management as business associate work; subcontractors need their own agreement. The minimum necessary standard limits data use to what each task needs. The Security Rule's technical safeguards require access control, audit controls, integrity, person or entity authentication and transmission security.
We use role-based access, audit logging and encrypted (HTTPS) connections, and we put a Business Associate Agreement in place before accessing patient data. For your side, use our HIPAA compliance checklist for medical practices.
We would rather tell you now than after you sign. Here is where we fit and where we do not.
A good fit if you are
Probably not a fit if you are
What we would do first if we were running your practice's revenue cycle tomorrow.
We check the Part B start date and the last IPPE or AWV before any Medicare wellness booking.
If a problem needs significant extra work at a preventive visit, we ask for a separate note and add modifier 25.
We confirm the practice is the patient's continuing focal point, then check the modifier 25 pairing. G2211 can pair with an AWV or vaccine administration, not a procedure.
APCM or separate care management, general BHI or collaborative care, RPM or RTM. We keep consent and initiating-visit dates in one place.
Part B vaccines bill to your Medicare contractor; we confirm the Part D billing path before any Part D shot.
Watch the CY 2027 final rule for the G2211 modifier proposal; plan for telehealth flexibilities ending December 31, 2027.
They usually cover coding support, claim scrubbing, submission, denial management and A/R follow-up for office visits, preventive and wellness visits, vaccines and care management. A good partner also handles same-day preventive and problem visits, Medicare wellness timing, G2211 and monthly care management rules. We add front-desk assistants, patient marketing and a claims portal, so one team owns the process from booking to payment.
Yes, when the problem needed significant extra work beyond the preventive exam. Bill the problem-oriented visit with modifier 25 and document it so it stands on its own. A minor problem handled within the exam is not billed separately. Commercial plans may apply a copay or deductible to the separately billed visit, while the preventive service stays free. Medicare does not allow an IPPE and an AWV on the same day.
The Initial Preventive Physical Exam is a once-in-a-lifetime visit within the first 12 months of Part B. After that, Medicare pays for an Annual Wellness Visit when the patient has had no IPPE or AWV in the past 12 months. The first AWV uses G0438, once per lifetime, and later visits use G0439. Medicare does not cover a routine physical exam.
G2211 is a Medicare add-on to office visits, and from 2026 to home or residence visits, when your practice is the patient's continuing focal point for care or gives ongoing care for a serious or complex condition. It is not payable when the visit carries modifier 25, unless the other service is an AWV, vaccine administration or allowed Part B preventive service. CMS has proposed turning it into a modifier for 2027.
Part B covers flu, pneumococcal and COVID-19 vaccines, plus hepatitis B for people at intermediate or high risk, with no deductible or coinsurance. Part D covers other commercially available vaccines, such as shingles, RSV and Tdap. For a Part D vaccine, your office can bill the plan through a web-based portal or a standard claim as an out-of-network prescriber, or send the patient to an in-network pharmacy.
Yes, for now. HHS and CMS say Medicare's broader telehealth flexibilities run through December 31, 2027, including visits at home and audio-only care. From January 1, 2028, under current law, patients generally must be in a medical facility in a rural area for telehealth other than behavioral health. Report POS 10 for a patient at home and POS 02 elsewhere.
Tell us about your practice. A member of our operations team replies within one business day.
Pricing is quoted after the audit, based on your volume and the services you choose. Prefer to talk? Call +1 (302) 556-2288.
Tell us about your practice
We use cookies to understand how our site is used and to measure our advertising. You can accept or reject non-essential cookies. See our Privacy Policy.
