Specialty
Family Medicine Billing and RCM
Newborns to nursing homes. Preventive care and acute problems, often in the same afternoon.
Why it’s different
Family medicine bills the widest range of any primary care specialty: well-child checks, immunizations, adult preventive visits, chronic disease management and same-day acute problems.
The complexity isn't in any single visit. It's in the number of different rule sets one afternoon can touch.
Common challenges
Where the money goes missing.
- Preventive Plus Problem
- Both performed on the same day, and payers that refuse to pay both without modifier 25.
- Immunization Administration
- Administration billed separately from the vaccine product, with counselling requirements attached.
- Well-Child Age Bands
- Preventive codes tied to age bands and periodicity schedules that vary by payer.
- Annual Wellness Visit
- Medicare AWV billed as a routine physical, which Medicare does not cover.
- Chronic Care Management
- Time thresholds documented in the chart but never converted to a claim.
How we help
We verify preventive and problem codes are correctly paired, check immunization administration against the products given, and confirm age-band and periodicity rules for each payer before submission.
We do not provide coders. Your clinical team assigns the codes. We verify and validate them.
Key codes
- CPT 99202–99215
- CPT 99381–99397
- CPT 90460–90474
- HCPCS G0438 / G0439
- Modifier 25
Indicative, not exhaustive. Code sets and payer policies change.
Get a Family Medicine Billing Analysis
Send us a sample of your denials. We'll tell you what's actually driving them in your specialty.