Specialty
Family practice billing services
Family practice billing services cover the widest code range of any office specialty: problem visits leveled by decision making or time, preventive visits by age, Medicare wellness visits, vaccines with their administration codes, in-office procedures and tests, and chronic care management between visits.
See where claims are getting stuck. No patient data needed.
Remitwright gives family practices a dedicated biller who levels visits from the note, bills the preventive and the problem visit correctly on the same day, keeps the vaccine and procedure charges from being missed, and reports weekly.
Family practice billing is one of Remitwright's specialty billing services, each set out with its own code families, denial reasons and payer rules.
Last reviewed by the Remitwright billing team. Editorial policy
- 17110
- 90471-90474
- 99202-99215
Denials
Why family practice claims get denied
The reasons that come up most on family practice remittances, with the usual cause and the fix. Code explanations are our own; the official list is maintained by X12.
| Code | Reason | Usual cause | The fix |
|---|---|---|---|
| CO-97 | Bundled, not separately payable | A problem visit billed with a preventive visit or a procedure without modifier 25, or without a separately documented service | Modifier 25 only when the note shows a separate problem addressed, and a scrubber rule that stops the claim when the modifier is missing |
| CO-50 | Not medically necessary or too frequent | A wellness visit billed inside the frequency limit, or a screening billed more often than the plan allows | Frequency limits recorded at eligibility and the last date checked before the visit is scheduled |
| CO-96 | Non-covered service | A routine annual physical billed to Medicare, which does not cover it, instead of the wellness visit it does cover | Medicare patients scheduled and billed for the wellness visit, with any problem visit documented separately |
| CO-16 | Claim lacks information | Vaccine product billed without the administration code, or with the wrong units, or without the identifier some payers require | Charge capture that pairs every vaccine with its administration code and the units the payer expects |
| CO-4 | Procedure inconsistent with the modifier | Telehealth modifier and place of service combined in a way the payer does not accept | A per-payer telehealth rule set applied before release |
| CO-18 | Duplicate claim | A corrected claim sent as a new claim instead of a replacement | Corrections sent with the replacement frequency code against the original claim number |
Codes
Common family practice codes and modifiers
Code families by number with our own one-line explanations. CPT descriptors belong to the AMA and are not reproduced here.
| Codes | What the family covers |
|---|---|
| 17110, 11200, 10060, 20610, 69210, 36415 | Common in-office procedures and venipuncture, usually billed with the visit and modifier 25 when the note supports a separate evaluation |
| 90471-90474, G0008-G0010 | Vaccine administration codes, with Medicare's own codes for influenza, pneumococcal and hepatitis B administration, billed alongside the vaccine product code |
| 99202-99215 | New and established office visits, leveled by medical decision making or total time on the date of service |
| 99381-99397 | Preventive visits by age for new and established patients, covered by commercial plans and Medicaid and not by Medicare |
| 99490, 99491, 99439, 99495, 99496 | Chronic care management by clinical staff or the physician, and transitional care management after a discharge, each with time and documentation rules |
| G0402, G0438, G0439 | Medicare's initial preventive physical examination and the first and subsequent annual wellness visits, with their own required elements and frequency limits |
Modifiers that matter
- 25
- A separately identifiable problem-oriented visit on the same day as a procedure or a preventive visit. The note must document the problem visit apart from the procedure or preventive work.
- 33
- Marks a preventive service for commercial plans so cost sharing is waived where the plan follows the preventive rules; used on screenings billed with codes that are not inherently preventive.
- 95 and 93
- Telehealth by audio and video, and audio-only where the payer allows it, paired with the place of service the payer wants.
- 59 or XU
- Two procedures on the same day that the payer would otherwise bundle, with documentation showing they were distinct.
Payers
Payer notes
- MedicareOffice visit levels are selected by medical decision making or by total time on the date of the encounter under the framework in the Evaluation and Management Services Guide, and a visit billed with a procedure needs modifier 25 with documentation of a separately identifiable service.1
- MedicareChronic care management and transitional care management are billable under the rules on CMS's care management pages, which set the time, consent, care plan and timing requirements for each code.2
- MedicarePreventive services Medicare covers, including the initial preventive physical examination and annual wellness visits, are set out in the Benefit Policy Manual with their required elements and frequency limits; routine annual physicals are not a covered benefit.3
- Commercial plansMost apply NCCI procedure-to-procedure edits between visits and same-day procedures and medically unlikely edits on units, so the same-day combinations a family practice bills every day are paid only with the modifiers and documentation to match.4
Authorizations
Family practice visits rarely need prior authorization, but the referrals, imaging, specialty drugs and procedures a family practice orders often do under commercial and Medicaid plans, and the referring practice is usually the one that has to request it. Your biller keeps the authorization matrix for the payers and services you order most, flags an order that needs one before the referral goes out, and records the number so the downstream claim is not denied for a step that was yours.
Documentation traps
- Decision making elements not stated in the note, so the level cannot be defended; the problems addressed, the data reviewed and the risk of management need to be written down
- A preventive visit and a problem visit documented as one narrative, which makes modifier 25 indefensible
- Total time used to level a visit without the total time recorded on the date of service
- Wellness visit elements such as the health risk assessment and the written screening schedule missing, which turns the visit into a non-covered physical
- Vaccine lot, units and the administration route missing from the charge, so the product and administration lines do not match
What a specialist checks
Specialist or generalist for family practice billing?
A generalist biller can enter a family practice claim. Whether it pays turns on three things specific to family practice billing, and a specialty-aware biller checks each one.
Code families
Each family billed with what the chart has to show for it.
- 17110, 11200, 10060, 20610, 69210, 36415
- 90471-90474, G0008-G0010
- 99202-99215
Modifiers
Applied only where the note supports them, line by line.
- 25
- 33
- 95 and 93
If you are moving from another billing company or an in-house biller, switching billing companies follows a plan: the old and new processes run side by side until the new one is proven, and every login and every family practice claim stays in your name.
What we handle
What we handle for family practices
- Medical codingCPT, ICD-10 and modifiers assigned correctly
- Charge entryEvery encounter captured, nothing left unbilled
- Claim submissionScrubbed, submitted and tracked to acceptance
- Payment postingERAs and EOBs posted, variances flagged
- Denial managementEvery denial read, worked and appealed
- Eligibility verificationCoverage and benefits checked before visits
A dedicated biller with named cover, working inside your system and reporting to you on one written page. How it works sets out the five stages.
Software
Systems family practices usually run
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about family practice billing
Can we bill a physical and a sick visit on the same day?
Why does Medicare deny our annual physicals?
How are visit levels chosen now?
Can we bill chronic care management?
How should vaccines be billed?
What do you need from a family practice to start?
Next step
See where your family practice claims are getting stuck.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).