Family practice medical billing services looks straightforward on the surface office visits, preventive care, a few chronic conditions. In practice, it is one of the most billing-dense environments in outpatient medicine.

A busy family practice sees 20 to 30 patients a day across every age group, every payer type, and every level of visit complexity. The same provider delivers a Medicare Annual Wellness Visit in the morning, a problem-focused sick visit at noon, a chronic care management plan in the afternoon, and a telehealth follow-up at the end of the day each with its own CPT code, modifier requirement, documentation standard, and payer-specific rule.

When a billing team doesn’t understand these distinctions when preventive and problem visits get bundled without Modifier 25, when chronic care management codes go unbilled, when E/M levels default to 99213 regardless of visit complexity revenue walks out the door quietly, visit after visit, every single day.

At Malakos Healthcare Solutions, we provide specialized family practice and general practice medical billing services built around the full scope of what family medicine providers actually deliver. Accurate coding, clean claim submission, proactive denial management, and full revenue cycle transparency so your practice gets paid correctly for everything it does.

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Why Family Practice Billing Loses More Revenue Than Most Providers Realize

The revenue leaks in family practice billing are usually not dramatic. There’s no single catastrophic denial event. The losses are quiet and systematic a code level lower than documented, a modifier missing on a same-day visit, a chronic care management code never billed because the workflow didn’t capture it, a telehealth modifier applied incorrectly for months before anyone noticed.

Compounded across 20+ daily visits and thousands of claims per year, these small errors produce large revenue gaps.

Chronic undercoding of E/M visits. The 2021 AMA revisions to E/M guidelines made it significantly easier to justify 99214 and 99215 based on medical decision-making complexity and total time. Family practices managing patients with multiple chronic conditions, reviewing outside records, coordinating care with specialists, or spending extended time on documentation routinely qualify for higher-level codes but default to 99213 out of habit or caution.

Missed same-day service unbundling. When a family practice provider addresses a preventive care visit and a new or ongoing problem on the same date a very common scenario both services are separately reimbursable, but only with Modifier 25 on the problem-focused E/M. Without it, one service reimburses at zero. Across hundreds of visits per month, this represents significant lost revenue.

Chronic Care Management codes routinely unbilled. Medicare’s Chronic Care Management program pays for non-face-to-face care coordination services for patients with two or more chronic conditions. The codes (99490, 99491, 99487, 99489) are billable once per month per qualifying patient but require a structured workflow to capture and bill consistently. Most family practices with a large Medicare panel are leaving substantial monthly revenue uncaptured.

Annual Wellness Visit vs. preventive vs. problem visit confusion. Medicare’s Annual Wellness Visit (G0438/G0439) is not the same as a standard preventive visit and billing the wrong code type results in either underpayment or a compliance error. When a problem is also addressed during an AWV, an additional E/M is billable with Modifier 25 but this combination is frequently missed.

Telehealth and RPM billing applied incorrectly. Telehealth billing requires specific place of service codes and modifiers that vary by payer and visit type. Remote patient monitoring involves a distinct set of setup, data collection, and management codes with their own eligibility and consent requirements. Billing these incorrectly or not billing RPM at all is a common and ongoing revenue gap in primary care.

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Family Practice CPT Codes – Complete Reference with Payer Notes

Evaluation and Management – Office and Outpatient Visits

E/M visits are the highest-volume code category in family practice. Correct level selection – based on medical decision-making complexity or total time as of 2021 – is the single most impactful coding decision your practice makes every day.

CPT Code	Patient Type	MDM Complexity	Typical Time	Key Notes
99202	New patient	Straightforward	15 – 29 min	Minor presenting problems; self-limited conditions
99203	New patient	Low	30 – 44 min	Two or more self-limited conditions, or one stable chronic illness
99204	New patient	Moderate	45 – 59 min	One or more chronic illnesses with exacerbation; new problem requiring additional workup
99205	New patient	High	60 – 74 min	One or more chronic illnesses with severe exacerbation; threat to life or function
99211	Established patient	Minimal	5 – 10 min	May not require physician presence; nurse visit, prescription refill check
99212	Established patient	Straightforward	10 – 19 min	Self-limited or minor problem
99213	Established patient	Low	20 – 29 min	One stable chronic illness; acute uncomplicated illness
99214	Established patient	Moderate	30 – 39 min	One or more chronic illnesses with exacerbation; new problem with additional workup
99215	Established patient	High	40 – 54 min	Severe exacerbation; threat to life or bodily function; highly complex decision-making

2021 E/M rule changes what matters for family practice:

• E/M level can now be selected based on medical decision-making (MDM) OR total time on the date of encounter whichever supports the higher level.
• Total time includes pre-visit chart review, face-to-face time, ordering, documentation, and care coordination not just the face-to-face portion. Document total time explicitly in the note.
• Managing two or more stable chronic conditions (e.g., hypertension + diabetes) typically supports 99214 moderate complexity MDM not 99213. Defaulting to 99213 for these visits is systematic undercoding.
• Reviewing outside records, communicating with specialists, or explaining risks of a treatment decision independently contribute to MDM complexity.

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Preventive Medicine Visits

Preventive visits are distinct from problem-focused E/M visits in documentation requirements, coding, and patient cost-sharing under most plans.

CPT Code	Patient Type	Age Range	Notes
99381	New patient – preventive	Under 1 year
99382	New patient – preventive	1-4 years
99383	New patient -preventive	5-11 years
99384	New patient – preventive	12-17 years
99385	New patient – preventive	18-39 years
99386	New patient – preventive	40-64 years
99387	New patient – preventive	65+ years
99391	Established patient – preventive	Under 1 year
99392	Established patient – preventive	1-4 years
99393	Established patient – preventive	5-11 years
99394	Established patient – preventive	12-17 years
99395	Established patient – preventive	18-39 years
99396	Established patient – preventive	40-64 years
99397	Established patient – preventive	65+ years

Preventive + problem visit on the same date the Modifier 25 rule:

When a provider performs both a preventive visit and addresses a new or established problem requiring additional work on the same date, both services are separately billable. The E/M code for the problem-focused visit must be appended with Modifier 25 to indicate a significant, separately identifiable service was rendered.

Without Modifier 25, the payer bundles the problem visit into the preventive visit reimbursement. This is among the most common and most costly billing errors in family practice missed on hundreds of claims per year in a typical practice.

Documentation requirement: The problem addressed must be documented separately from the preventive visit content. A note that blends preventive and problem content without distinction does not support separate billing.

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Medicare-Specific Wellness and Preventive Visit Codes

Medicare has its own wellness visit structure that is distinct from the commercial preventive visit codes above. Billing the wrong code for a Medicare wellness visit is both a reimbursement error and a compliance risk.

CPT/HCPCS Code	Description	Notes
G0402	Initial Preventive Physical Examination (IPPE) “Welcome to Medicare”	One-time visit within first 12 months of Medicare Part B enrollment; focuses on health risk assessment, not physical examination per se
G0438	Annual Wellness Visit initial	First AWV after 12 months of Part B enrollment; creates personalized prevention plan
G0439	Annual Wellness Visit subsequent	Each year following initial AWV
G0444	Annual depression screening 15 minutes	Covered annually under Medicare; standalone or same-day with AWV
G0446	Annual alcohol misuse screening and brief counseling	15 minutes; covered annually
G0447	Face-to-face behavioral counseling for obesity	15 minutes per session; covered for BMI ≥30
G0101	Cervical or vaginal cancer screening	Pelvic and clinical breast examination
G0105	Colorectal cancer screening colonoscopy, high-risk patient
G0121	Colorectal cancer screening colonoscopy, average-risk patient

AWV billing rules that matter:

• The AWV (G0438/G0439) is not a physical examination in the traditional sense it is a health risk assessment and prevention planning visit. It does not require a head-to-toe physical exam.
• If the patient presents a new or established problem that is separately evaluated during the AWV, a standard E/M code (99213–99215) can be billed on the same date with Modifier 25.
• Do not bill 99213 or 99214 as a substitute for G0438/G0439 for Medicare patients presenting for their annual wellness visit. This is a coding error that creates compliance exposure.
• The IPPE (G0402) is a one-time benefit it cannot be billed again in subsequent years. It transitions to G0438 (initial AWV) the following year.

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Chronic Care Management (CCM)

Chronic Care Management is one of the most consistently underbilled revenue streams in family practice. Medicare pays monthly for non-face-to-face care coordination services for patients with two or more chronic conditions expected to last at least 12 months or until death.

Most family practices with a significant Medicare panel qualify to bill CCM codes but few have a structured workflow to capture and bill them consistently.

CPT Code	Description	Time Requirement	Notes
99490	CCM clinical staff time, first 20 minutes per month	20 min/month	Requires written patient consent; structured care plan; 24/7 access to care team
99439	CCM clinical staff time, each additional 20 minutes	+20 min	Add-on to 99490
99491	CCM physician/QHP personal time, first 30 minutes	30 min/month	When physician (not clinical staff) directly performs CCM services
99437	CCM physician/QHP personal time, each additional 30 minutes	+30 min	Add-on to 99491
99487	Complex CCM first 60 minutes per month	60 min/month	Requires moderate or high complexity MDM; typically for patients with multiple complex conditions
99489	Complex CCM each additional 30 minutes	+30 min	Add-on to 99487

CCM requirements checklist:

• Patient must have two or more chronic conditions (diabetes, hypertension, COPD, heart failure, CKD, depression, osteoporosis, etc.)
• Written patient consent must be obtained and documented before billing
• A comprehensive care plan must be created, maintained, and shared with the patient
• 24/7 access to a care team member must be available to the patient
• Electronic care plan must be accessible to all treating providers
• Only one provider can bill CCM for a patient in a given month
• CCM time must be documented with the date, duration, and description of activity

Revenue impact: At Medicare’s reimbursement rate, a family practice billing 99490 for 100 eligible patients per month generates approximately $4,000–$5,000 in additional monthly revenue for care coordination work that is already being done but never captured and billed.

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Transitional Care Management (TCM)

TCM codes cover the care management work done when a patient is discharged from an inpatient facility, skilled nursing facility, or hospital outpatient observation. They are frequently unbilled despite the significant work involved.

CPT Code	Description	Complexity	Contact Requirements
99495	TCM moderate complexity	Moderate MDM	Interactive contact within 2 business days of discharge; face-to-face visit within 14 days
99496	TCM high complexity	High MDM	Interactive contact within 2 business days of discharge; face-to-face visit within 7 days

TCM billing rules:

• Interactive contact (phone, email, or face-to-face) must occur within 2 business days of discharge
• The face-to-face visit must occur within the required timeframe and is included in the TCM service do not bill a separate E/M for the TCM follow-up visit
• Document the discharge date, date of interactive contact, and date of face-to-face visit
• TCM cannot be billed in the same month as CCM for the same patient

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Telehealth and Virtual Care Billing

Telehealth billing for family practice requires correct place of service codes, modifiers, and in some cases specific telehealth-only CPT codes all of which vary by payer.

Code/Modifier	Description	When to Use
POS 02	Telehealth provided other than in patient’s home	Office-based telehealth where provider is in the office
POS 10	Telehealth provided in patient’s home	Provider in office, patient in their home
Modifier 95	Synchronous telemedicine service real-time audio/video	Required by most commercial payers for telehealth E/M visits
Modifier GT	Via interactive audio and video telecommunications	Required by some payers (particularly Medicaid) in place of or alongside Modifier 95
Modifier 93	Synchronous telemedicine service telephone only (audio-only)	For audio-only visits where video is not available; lower reimbursement; coverage varies by payer
99421	Online digital E/M 5-10 minutes cumulative over 7 days	Asynchronous patient-initiated digital communication (patient portal messages)
99422	Online digital E/M 11-20 minutes
99423	Online digital E/M 21+ minutes
G2012	Brief check-in by telephone 5-10 minutes	Virtual check-in; not initiated by provider; patient must consent
G2010	Remote evaluation of pre-recorded images/video	Patient-submitted photo or video reviewed by provider

Payer-specific telehealth rules:

• Medicare covers most office-based E/M codes via telehealth with POS 02 or POS 10 and does not require Modifier 95 (though some MACs prefer it). Coverage rules have expanded significantly post-PHE.
• Commercial payers vary widely most require Modifier 95 and either POS 02 or POS 10. Some still require GT for Medicaid plans. Always verify payer-specific telehealth billing requirements before submitting.
• Audio-only visits are covered by some payers with Modifier 93 but at reduced rates. Medicare covers audio-only under specific conditions verify per payer.
• Online digital E/M (99421–99423) covers asynchronous portal-based communication that requires clinical evaluation and decision-making. These are frequently unbilled despite representing significant provider time.

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Remote Patient Monitoring (RPM)

RPM is a growing revenue stream for family practices managing chronic conditions like hypertension, diabetes, and heart failure. It is also one of the most consistently underbilled service categories in primary care.

CPT Code	Description	Notes
99453	RPM initial device setup and patient education	Billed once per device setup; covers onboarding and education
99454	RPM device supply with daily recordings, 30-day period	Billed per 30-day period; requires at least 16 days of data in the 30-day period
99457	RPM treatment management, first 20 minutes per month	Clinical staff or physician time; interactive communication with patient required
99458	RPM treatment management, each additional 20 minutes	Add-on to 99457
99091	Collection and interpretation of physiologic data 30 minutes	Physician personal time reviewing and interpreting RPM data

RPM billing requirements:

• Patient must provide verbal or written consent before RPM enrollment document in the chart
• Device must collect data at least 16 out of 30 days to bill 99454 in that month
• 99457 requires interactive communication (not just data review) a touchpoint with the patient or caregiver must be documented
• RPM and CCM can be billed in the same month for the same patient but combined time must be tracked and documented separately
• Most major commercial payers now cover RPM for qualifying chronic conditions, though prior authorization requirements vary

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Preventive Counseling and Behavioral Health Integration

CPT Code	Description	Notes
99401	Preventive counseling individual, approximately 15 minutes	Risk factor reduction; not illness-driven
99402	Preventive counseling individual, approximately 30 minutes
99403	Preventive counseling individual, approximately 45 minutes
99404	Preventive counseling individual, approximately 60 minutes
99411	Preventive counseling group, approximately 30 minutes	Two or more patients
99412	Preventive counseling group, approximately 60 minutes
96156	Health behavior assessment 30 minutes	Behavioral interventions for physical health conditions
96158	Health behavior intervention individual, 30 minutes	Chronic disease self-management; pain management; lifestyle modification
96159	Health behavior intervention each additional 15 minutes	Add-on

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In-Office Procedures Commonly Billed by Family Practice

Family practices that perform in-office procedures often unbilled or underbilled have significant additional revenue potential.

CPT Code	Description	Notes
93000	ECG with interpretation and report	Extremely common; ensure interpretation note is in the chart
94010	Spirometry	Requires pre- and post-bronchodilator documentation for COPD workup
69210	Removal of impacted cerumen	Bill per ear; document each side separately
10060	Incision and drainage simple	Document location, size, technique
10061	Incision and drainage complicated
11200	Removal of skin tags up to 15
11201	Removal of skin tags each additional 10	Add-on to 11200
17000	Destruction of premalignant lesion first
17003	Destruction of premalignant lesion 2nd through 14th	Add-on
17110	Destruction of benign lesions up to 14
17111	Destruction of benign lesions 15 or more
20600	Aspiration/injection small joint
20610	Aspiration/injection major joint (knee, shoulder)	Document substance injected and laterality
36415	Routine venipuncture
81001	Urinalysis with microscopy
85025	CBC with differential
80053	Comprehensive metabolic panel
87880	Strep A rapid test
87804	Influenza rapid test
90471	Immunization administration first injection
90472	Immunization administration each additional injection
90460	Immunization administration with counseling under 18, first
90461	Immunization administration with counseling under 18, each additional

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Prolonged Services

CPT Code	Description	Notes
99354	Prolonged service office, first additional 30–60 minutes	Use when face-to-face time exceeds the maximum time for 99215 (54 min); document total time
99355	Prolonged service office, each additional 30 minutes	Add-on to 99354
99358	Prolonged service non-face-to-face, first hour	Chart review, care coordination outside visit
99359	Prolonged service non-face-to-face, each additional 30 minutes
G2212	Prolonged office visit Medicare-specific	Medicare’s version of 99354/99355; required for Medicare claims

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Modifier Reference for Family Practice Billing

Modifier	When to Use	What Happens Without It
25	Significant, separately identifiable E/M on same day as preventive visit or minor procedure	E/M bundled into preventive or procedure; paid at zero
57	E/M decision for major surgery performed the following day	Without 57, E/M on day before surgery may be bundled into global surgical package
24	Unrelated E/M during global surgical period	Payer rejects E/M as bundled into global period payment
59	Distinct procedural service	Secondary service denied or bundled without clinical distinction documented
33	Preventive service waives patient cost-sharing (ACA)	Required for first-dollar preventive services under ACA-compliant plans
95	Synchronous telemedicine audio/video	Required by most commercial payers for telehealth E/M visits
GT	Via interactive audio/video telecommunications	Required by some Medicaid and commercial payers for telehealth
93	Synchronous telemedicine telephone only	Required for audio-only visits where covered
GX	Notice of liability issued, voluntary under payer policy
GA	Waiver of liability on file (ABN signed)	Required when Medicare patient signs ABN for potentially non-covered service
GZ	Item/service expected to be denied no ABN	Documents lack of ABN when service may not be covered

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ICD-10 Codes Commonly Used in Family Practice

Family practice covers the broadest ICD-10 code range of any specialty. Below are the most frequently billed diagnosis categories with key coding notes.

Chronic Disease Management

ICD-10 Code	Description	Notes
E11.9	Type 2 diabetes without complications	Specify complications when documented (E11.40, E11.65, etc.)
E11.65	Type 2 diabetes with hyperglycemia	More specific than E11.9 when hyperglycemia documented
I10	Essential hypertension	Most common chronic disease code in family practice
E78.5	Hyperlipidemia, unspecified	Use E78.00 for pure hypercholesterolemia when documented
E66.01	Morbid obesity	Specify BMI code (Z68.x) as secondary diagnosis
J44.1	COPD with acute exacerbation	Use J44.0 for COPD with acute lower respiratory infection
J44.0	COPD with acute lower respiratory infection
I50.9	Heart failure, unspecified	Specify type when documented (systolic/diastolic, acute/chronic)
N18.3	Chronic kidney disease, stage 3	Always code CKD stage when documented
M81.0	Age-related osteoporosis without fracture

Acute and Episodic Conditions

ICD-10 Code	Description	Notes
J06.9	Acute upper respiratory infection, unspecified
J02.9	Acute pharyngitis, unspecified	Use J02.0 when strep-confirmed
J02.0	Streptococcal pharyngitis	Requires positive strep test documentation
J20.9	Acute bronchitis, unspecified
J03.90	Acute tonsillitis, unspecified
N39.0	Urinary tract infection	Specify organism when culture results available
L03.90	Cellulitis, unspecified	Specify site when documented
S codes	Injury and trauma	Always use 7th character for encounter type (A = initial, D = subsequent, S = sequela)

Mental and Behavioral Health (Commonly Co-Managed in Primary Care)

ICD-10 Code	Description	Notes
F32.1	Major depressive disorder, single episode, moderate
F33.1	Major depressive disorder, recurrent, moderate
F41.1	Generalized anxiety disorder
F41.9	Anxiety disorder, unspecified	Use when specific type not documented
F10.10	Alcohol use disorder, mild
F17.210	Nicotine dependence, cigarettes, uncomplicated	Document nicotine dependence for tobacco cessation counseling

Preventive and Screening

ICD-10 Code	Description	Notes
Z00.00	Encounter for general adult medical exam without abnormal findings	Use for preventive visits
Z00.01	Encounter for general adult medical exam with abnormal findings	When findings discovered during preventive visit
Z12.11	Encounter for screening for malignant neoplasm of colon
Z12.31	Encounter for screening for malignant neoplasm of prostate
Z23	Encounter for immunization	Always pair with the vaccine product code (90x series)
Z68.x	Body mass index	Secondary code; always document when obesity is coded

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Common Reasons Family Practice Claims Get Denied And How We Fix Each One

1. Preventive and problem visit bundled Modifier 25 missing When both a preventive visit and a problem-focused E/M are delivered on the same date, the E/M reimburses at zero without Modifier 25. This is the highest-frequency modifier error in family practice.

Our fix: We identify same-day visit combinations in the charge data before submission and apply Modifier 25 consistently. We also verify that the clinical note documents the problem separately from the preventive content.

2. E/M level defaults to 99213 regardless of documented complexity Practices managing patients with multiple chronic conditions routinely qualify for 99214 moderate complexity MDM under 2021 guidelines but bill 99213 out of habit.

Our fix: We review E/M documentation against current AMA MDM and time-based criteria and apply the code level the visit actually supports. We provide ongoing E/M distribution analysis in monthly reports so undercoding patterns are visible and actionable.

3. CCM never billed despite qualifying patient panel Practices with Medicare patients managing two or more chronic conditions qualify to bill CCM monthly but often lack the capture workflow to do so consistently.

Our fix: We work with your team to identify your qualifying CCM patient panel, build a monthly billing cadence, and ensure the documentation requirements patient consent, care plan, time tracking are met and captured.

4. Medicare AWV billed as standard E/M G0438/G0439 is incorrectly billed as 99213/99214 for Medicare annual wellness visits, resulting in claim rejection or underpayment.

Our fix: We identify Medicare patients by payer and visit type and apply the correct G codes for AWVs. When a separately identifiable E/M is also documented, we apply Modifier 25 and bill both correctly.

5. Telehealth modifier errors POS codes and modifiers (95, GT, 93) are applied incorrectly or inconsistently, resulting in denials or downcoded reimbursement.

Our fix: We maintain a current payer-specific telehealth billing reference and apply the correct POS code and modifier combination by payer for every telehealth claim. Payer rule changes are tracked and applied as they occur.

6. TCM unbilled after hospital discharges TCM codes (99495/99496) represent significant reimbursement for work that is already being done but are missed because the billing workflow doesn’t prompt capture after discharge.

Our fix: We track discharge notifications and flag TCM opportunities in your billing workflow. Contact date, face-to-face visit date, and complexity are verified before billing.

7. In-office procedures coded without correct documentation Minor procedures like joint injections, skin tag removals, and cerumen removal are frequently billed without the clinical documentation required to support the code laterality, size, substance, technique.

Our fix: We review procedure documentation before billing and flag incomplete notes for clarification before the claim goes out. Common in-office procedure documentation requirements are built into our pre-submission review checklist.

8. Vaccine administration codes missing or incorrect Immunization administration codes (90471/90472 or 90460/90461 for patients under 18) are frequently omitted, submitted without the corresponding vaccine product code, or billed with the wrong age-specific code.

Our fix: We verify that every vaccine claim includes both the administration code and the vaccine product code, with the correct age-appropriate administration code applied. Counseling component (90460/90461) is confirmed for pediatric patients.

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Our Family Practice Billing Services Full Scope

Malakos Healthcare Solutions provides end-to-end revenue cycle management for family medicine practices, general practice clinics, and internal medicine practices across the United States.

Eligibility & Benefit Verification We verify coverage, deductibles, co-pays, co-insurance, and visit-specific benefit rules before every appointment. Preventive vs. diagnostic coverage distinctions, CCM enrollment status, and authorization triggers are confirmed before treatment never discovered on a denial.

Prior Authorization Management We manage authorization requirements for imaging, specialist referrals, and procedure-specific auth triggers across your payer mix. Authorization status is tracked proactively and renewals initiated before current auths expire.

Family Practice Specialty Coding Our coders understand the full scope of family medicine E/M level selection under 2021 guidelines, preventive visit coding, same-day visit unbundling, CCM and TCM coding, telehealth and RPM codes, in-office procedure coding, and Medicare-specific visit codes. Every claim is reviewed for coding accuracy and compliance before submission.

Charge Capture Optimization We review your practice’s charge capture workflow to identify services being rendered but not billed particularly CCM, TCM, RPM, online digital E/M, and in-office procedures. Revenue you’re already earning but not collecting is the fastest path to improved collections.

Claim Submission & Scrubbing Every charge is scrubbed against specialty-specific billing rules, modifier requirements, and payer-specific edits before electronic submission. Clean-claim rates directly impact your payment cycle speed.

Denial Management We categorize every denial by root cause, appeal claims with supporting documentation, and track systemic denial patterns across payers. Root cause fixes not just individual claim remediation are how we reduce denial rates over time.

AR Follow-Up We work your aging AR on a structured 15/30/60-day cycle. No claim ages past 60 days without a documented escalation and action.

Payment Posting & Underpayment Recovery Every EOB and ERA is posted and reconciled against contracted rates. Underpayments including automatic claim adjustments applied below contracted amounts are identified and appealed.

Monthly Reporting & Analytics You receive detailed monthly reports covering collections by payer and service type, E/M code distribution analysis, denial rates by CPT and payer, AR aging, and CCM/RPM billing performance. Full financial visibility into every part of your practice’s revenue.

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Why Family Practice Providers Choose Malakos Healthcare Solutions

Primary care depth. We understand the full billing scope of family medicine not just E/M coding but CCM, TCM, AWV, RPM, telehealth, in-office procedures, and preventive care and how each one interacts in a busy daily practice.

Proactive revenue capture. We don’t just submit what’s entered. We identify services being rendered but not billed CCM, RPM, online digital E/M, same-day unbundling opportunities and build the workflow to capture them consistently.

E/M level accuracy. We apply 2021 AMA E/M guidelines consistently and provide E/M distribution reports that make undercoding patterns visible. Most family practices find material revenue improvement in E/M coding alone.

HIPAA-compliant operations. All data handling follows strict HIPAA protocols. A Business Associate Agreement (BAA) is included with every engagement.

EHR compatibility. We work within your existing platform eClinicalWorks, Athenahealth, Kareo, AdvancedMD, Epic, Modernizing Medicine, and most other major family practice EHR and PM systems.

Dedicated account manager. One contact who knows your payer mix, your patient population, and your billing history. No support queues.

No long-term contracts. We earn your business through results month to month from day one.

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Frequently Asked Questions — Family Practice Billing

What is the most common billing error in family practice? The single most common and most costly error is missing Modifier 25 when a preventive visit and a problem-focused E/M are delivered on the same date. Without Modifier 25 on the E/M code, the payer bundles both services together and reimburses only the preventive visit rate the E/M is paid at zero. In a busy family practice, this can affect dozens of visits per month.

How does the 2021 E/M overhaul affect family practice billing? The 2021 AMA changes eliminated the old exam component from E/M level selection. Level is now determined by medical decision-making complexity or total time on the date of encounter including pre-visit chart review, documentation, and care coordination. For family practices managing patients with multiple chronic conditions, this change makes higher-level codes (99214, 99215) significantly easier to justify and document. Practices that haven’t updated their coding habits since 2021 are likely systematically undercoding.

What is Chronic Care Management and how does billing work? CCM covers non-face-to-face care coordination for Medicare patients with two or more chronic conditions. It’s billed monthly using CPT codes 99490/99439 (clinical staff time) or 99491/99437 (physician time), with 99487/99489 for complex CCM. Requirements include written patient consent, a documented care plan, 24/7 access, and monthly time tracking. It’s one of the most consistently underbilled programs in family practice and for practices with large Medicare panels, it represents significant monthly recurring revenue.

Can telehealth visits be billed at the same rate as in-person visits? For Medicare, telehealth E/M visits via synchronous audio/video are reimbursed at the same rate as equivalent in-person visits when billed with the appropriate POS code and modifiers. Commercial payer telehealth parity varies some states have parity laws requiring equal reimbursement, others do not. Audio-only visits are typically reimbursed at lower rates and have more limited coverage. We track telehealth billing rules by payer and apply the correct codes and modifiers for each.

What is Transitional Care Management and when can it be billed? TCM covers the care management work performed when a patient transitions home after a hospital, SNF, or observation stay. It requires an interactive contact within 2 business days of discharge and a face-to-face visit within 7 days (99496, high complexity) or 14 days (99495, moderate complexity). It’s frequently unbilled because the billing workflow doesn’t capture discharge events and trigger the TCM process. We track discharge notifications and prompt TCM capture as part of our standard workflow.

How quickly can we get started? Most family practices are fully onboarded within 7-14 business days. We begin with a free billing audit, followed by a kickoff call to review your payer mix, patient demographics, EHR platform, and current workflow. Transition runs in parallel with your existing process no interruption to billing or cash flow during the switch.

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Ready to Capture the Revenue Your Family Practice Has Been Missing?

If your practice is dealing with undercoded E/M visits, unbilled CCM or TCM, telehealth modifier errors, or a billing operation that can’t keep up with the volume and complexity of primary care we can help.

A free billing audit will show you exactly where your practice is losing revenue and what it would take to recover it.

Schedule Your Free Billing Audit

📞 +1 (307) 441-3431 ✉️ support@malakoshcs.com

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Malakos Healthcare Solutions | Family Practice Medical Billing Services USA | Serving independent family medicine and general practice clinics nationwide