Specialty billing
Family practice billing services
Family practice billing is coding and claiming the care a family medicine practice gives patients of every age, from well-child checks and vaccines to chronic care and Medicare wellness visits.
Family medicine
One preventive visit, three code sets
- Commercial and Medicaid99381–99397By age, new or established
- MedicareG0402G0438G0439Welcome visit, then wellness visits
- Vaccines9046090471A product code and an administration code
Try it
Find the preventive visit code
Preventive visits are coded by the patient’s age and whether they are new or established; Medicare uses its own codes.
Which preventive visit code?
By ageMedicare uses its own codes; other plans code by age.
- 99395
Preventive visits are coded by the patient’s age and whether they are new or established. A problem treated in the same visit is billed separately, with modifier 25.
Why is family practice billing hard?
Preventive visits are coded by age
Preventive visits are coded by the patient’s age and whether they are new or established (99381–99397). Medicare uses its own codes instead: the Welcome to Medicare visit (G0402) and annual wellness visits (G0438, G0439).
A problem inside a preventive visit
When a problem is treated during a preventive visit, it is billed as a separate visit with modifier 25, and the patient may owe cost sharing for that part. The note has to show the work for each.
Each vaccine is billed twice
A vaccine has a product code and an administration code. Administration with counseling for patients through age 18 uses 90460 and 90461; others use 90471–90474. Vaccines from the Vaccines for Children program aren’t billed as if the practice bought them.
Many payers on one schedule
A family practice bills commercial plans, Medicaid, Medicare and Medicare Advantage on the same day, each with its own preventive schedule and coverage rules.
What Beeline handles for family medicine practices
- Eligibility verificationCoverage and preventive benefits checked before the visit, so the practice knows whether a preventive visit or vaccine is covered.
- Medical codingPreventive and problem visits coded apart, with modifier 25 where the note supports both, and each vaccine with its administration codes.
- Claims submissionClaims checked for age, frequency and bundling edits before they are sent.
- Denial managementDenied preventive, vaccine and modifier 25 claims traced to their cause, then corrected or appealed.
- Payment postingPayments posted line by line, so a vaccine paid without its administration, or the other way round, is caught.
Family practice billing questions
Can a preventive visit and a sick visit be billed on the same day?
What is the difference between 90460 and 90471?
Is the Medicare annual wellness visit a physical?
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