Specialty
Geriatrics billing services
Geriatrics billing services follow older patients to wherever they are seen, and the place of service picks the code: office visits in the clinic, home or residence visits in a house or assisted living, nursing facility visits in a skilled or long-term bed, each with its own prolonged time code.
See where claims are getting stuck. No patient data needed.
Around those sit the Medicare services built for this age group: the annual wellness visit, advance care planning with modifier 33, cognitive assessment and care planning, and the hospice and QMB rules that decide who can be billed at all. Remitwright gives geriatric practices a dedicated biller who sets each visit's code and place of service from the note and works denials back to the cause.
Geriatrics 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
- 99304-99310
- 99341-99350
- 99483
Denials
Why geriatrics claims get denied
The reasons that come up most on geriatrics 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-119 | Wellness visit billed too soon | G0439 billed within 12 months of the last annual wellness visit, G0438 billed for a patient who already had one, or a wellness visit within 12 months of the IPPE | Prior wellness and IPPE dates confirmed in the patient's eligibility record before the visit is booked |
| CO-B9 | Hospice election not on the claim | A visit for a patient who has elected hospice billed without GV or GW | Hospice election read on every eligibility check, and each note marked as related or unrelated to the terminal condition |
| CO-5 | Visit code does not fit the place | Nursing facility codes billed for an assisted living resident, home or residence codes sent with POS 31 or 32, or office codes used for a facility visit outside the practice's designated office there | Place of service taken from the facility and stay type, and the visit code family matched to it |
| CO-97 | Cognitive care planning billed with a visit | 99483 billed on the same day as an office visit, a home or residence visit, or advance care planning | Same-day pairs checked against the CMS list before 99483 is released, with the wellness visit added under modifier 25 when done together |
| CO-170 | Wrong practitioner for the mandated visit | A nurse practitioner billed the initial federally mandated visit in a skilled nursing facility, which the physician must perform personally | Initial SNF visits assigned to the physician, with later mandated visits alternated with a qualified practitioner where the physician chooses |
| CO-4 | Split or shared where it is not allowed | FS used on a nursing facility visit or an office visit, neither of which Medicare treats as split or shared | FS kept to SNF and hospital visits where the billing practitioner did the substantive portion |
Codes
Common geriatrics 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 |
|---|---|
| 99304-99310, 99315, 99316 | Nursing facility care: initial and subsequent visits, each a once-a-day service, and discharge day management, with G0317 for prolonged time after the top initial or subsequent level. |
| 99341-99350 | Home or residence visits in a house, an assisted living facility, a group home or a custodial care facility, with G0318 for prolonged time. A visit billed with POS 12 requires the practitioner to be in the home, though the patient need not be homebound. |
| 99483 | Cognitive assessment and care planning for a patient whose impairment was already detected at a wellness or routine visit, ending in a written care plan shared with the patient or caregiver, with the G2212 add-on when the visit runs long. |
| 99497, 99498 | Advance care planning counted in minutes: nothing billable at 15 minutes or less, the base code from 16 minutes and the add-on once the talk reaches 46. It can be billed in any setting, as often as needed, with any change in the patient's wishes or health documented. |
| G0402, G0438, G0439 | The initial preventive physical examination, the first annual wellness visit (once in a lifetime) and every later one, each AWV at most once in 12 months and never within 12 months of the IPPE. |
| G2211 | The add-on for the practitioner who carries a patient's ongoing care, billed with office visits and, from January 1, 2026, with home or residence visits. |
Modifiers and claim codes that matter
- 33
- On advance care planning done the same day as the annual wellness visit, by the same provider and on the same claim. Medicare then waives the ACP deductible and coinsurance, unless the wellness visit itself is denied as too soon.
- 25
- On a problem-oriented visit billed with the annual wellness visit, and on the claim when the wellness visit is done in the same visit as cognitive assessment and care planning.
- GV and GW
- For a patient who has elected hospice. GV marks care for the terminal condition by the attending physician the patient chose, when the hospice neither employs nor pays that physician; GW marks care unrelated to that condition.
- AI
- Added only by the principal physician of record to the initial nursing facility visit. Other physicians and practitioners bill the same initial codes without it.
- POS 12, 13, 31 and 32
- Home, assisted living, a Part A skilled nursing stay, and a nursing facility or a SNF stay Part A does not cover. Nursing facility codes go with 31 or 32 (or 54 and 56), and home or residence codes never do.
How geriatrics billing differs from internal medicine and family practice
Internal medicine and family practice bill mostly from the office: visit levels, preventive visits by age, vaccines and in-office tests, with care management between visits. Those rules are on the internal medicine billing and family practice billing pages, and monthly care management has its own chronic care management billing page.
Geriatrics billing moves with the patient into homes, assisted living and nursing facilities, where the place of service picks the code family and Medicare sets a schedule of mandated facility visits. It also carries the Medicare work this age group needs most: wellness visits, advance care planning, cognitive care planning, and the hospice and QMB rules. The facility's own Part A claim is a separate stream, set out on the skilled nursing billing page.1
Payers
Payer notes
- MedicareThe initial federally mandated visit must happen no later than 30 days after admission, and later mandated visits at least once every 30 days for the first 90 days and once every 60 days after that. Medicare pays the physician or practitioner for one E/M visit per patient per day, and a mandated visit can double as the medically necessary one.1
- MedicareIn a SNF the physician cannot delegate the initial mandated visit, but may alternate later ones with a qualified nonphysician practitioner. In a nursing facility, a nurse practitioner, physician assistant or clinical nurse specialist not employed by the facility may do the initial visit where the state allows it. Incident-to visits are not paid in the facility setting.1
- MedicareNursing facility codes take POS 31 when the patient is in a Part A SNF stay, and POS 32 when there is no Part A SNF benefit, the patient is in a nursing facility, or the SNF stay is not covered, for example with no preceding 3-day hospital stay.1
- MedicareThe annual wellness visit is billed once in 12 months and never within 12 months of the IPPE. The first wellness visit must include a health risk assessment, detection of cognitive impairment, a depression risk review and a functional ability and safety check; later visits update the risk assessment and check again for cognitive impairment. Advance care planning is optional at either. A separately identifiable problem visit the same day is billed with modifier 25.2
- MedicareThe patient pays nothing for the wellness visit when the provider accepts assignment, and the Part B deductible does not apply. Coinsurance and the deductible can apply to other tests or services done at the same visit.7
- MedicareAdvance care planning is voluntary, and the note records that it was voluntary, the explanation of advance directives, who was present and the time spent. If the wellness visit is denied for exceeding the once-a-year limit, the ACP deductible and coinsurance apply again.3
- Medicare99483 cannot be billed on the same day as office visits 99202-99215, home visits 99341-99350, advance care planning or several psychiatric and assessment codes. Physicians, nurse practitioners, clinical nurse specialists and physician assistants can furnish it in the office, a home, a care facility or by telehealth.4
- Medicare and Medicare AdvantageProviders cannot bill patients in the QMB program for Medicare deductibles, coinsurance or copayments, even when Medicaid does not cover the full amount. QMB status shows in the 270/271 eligibility response and on remittance advice, and any QMB cost sharing billed or collected must be recalled or refunded.5
- MedicareFor a patient enrolled in hospice, MACs deny professional claims that carry neither GV nor GW, and they may review GW claims before or after payment to confirm the care was unrelated to the terminal condition.6
Authorizations
Original Medicare has no prior authorization step for nursing facility, home or wellness visits. Its limits are built into the codes: the 12-month spacing of the wellness visit, the federally mandated visit schedule, and the same-day pairs that cannot be billed together. Medicare Advantage and Medicaid managed care plans write their own rules for home visits and care planning, and for dual-eligible patients they decide what the Medicaid side pays. Your biller checks each plan's policy before a new facility or home visit program starts and keeps the answer with the patient's coverage record.
Documentation traps
- A home visit note that does not show the practitioner was in the home, which POS 12 requires
- Facility visits charted without the patient's stay type, so POS 31 or 32 is guessed
- Advance care planning notes missing who was present, the minutes spent or that the conversation was voluntary
- A cognitive assessment that never produces the written care plan shared with the patient or caregiver
- No record of whether a hospice patient's visit addressed the terminal condition, leaving GV or GW to guesswork
What a specialist checks
Specialist or generalist for geriatrics billing?
A generalist biller can enter a geriatrics claim. Whether it pays turns on three things specific to geriatrics billing, and a specialty-aware biller checks each one.
Code families
Each family billed with what the chart has to show for it.
- 99304-99310, 99315, 99316
- 99341-99350
- 99483
Modifiers and claim codes
Each one used only where the record supports it.
- 33
- 25
- GV and GW
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 geriatrics claim stays in your name.
What we handle
What we handle for geriatrics practices
- Medicare billingPart B claims, MSP, ABNs and appeals
- Medicaid billingState and MCO claims under each plan's rules
- Secondary claims billingSecondary and tertiary claims, tracked
- Medical codingCPT, ICD-10 and modifiers assigned correctly
- Patient billing supportStatements, questions and payment plans handled
- Denial managementEvery denial read, worked and appealed
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.
Worked example: the assisted living round
A geriatrician spends a morning at an assisted living community and the afternoon at a nursing facility across the street. Every note reaches billing under one facility heading, so the assisted living visits go out as subsequent nursing facility care with POS 32. They are denied, because assisted living residents are seen under the home or residence codes with POS 13.
The biller rebills the assisted living visits under the home or residence codes with POS 13 and keeps the nursing facility visits on the nursing facility codes, checking each resident's stay type, since a Part A skilled stay takes POS 31. The rounding list now carries the building and the stay type next to each name.
Software
Systems geriatrics practices usually run
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about geriatrics billing
Which codes do we use for assisted living residents?
Which place of service goes on a nursing facility visit?
Can a nurse practitioner do the nursing facility visits?
How do we bill advance care planning with the wellness visit?
Can we bill 99483 and the wellness visit on the same day?
What changes when a patient elects hospice?
Can we bill a QMB patient's coinsurance?
What does a geriatric practice provide so billing can start?
Next step
See where your geriatrics 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).