What are the highest-paying CPT codes for family practice?

The highest-paying individual CPT codes are 99215 (complex established visit), 99205 (complex new patient visit), and 99496 (high-complexity TCM with 7-day face-to-face). For recurring revenue, CPT 99490 (CCM) and G0438 (initial AWV) are the most impactful over time. Combining high-level E/M codes with CCM and AWV programs generates the most revenue per patient per year.

What is the difference between 99213 and 99214?

99213 requires low medical decision-making complexity or 20–29 minutes of total provider time. 99214 requires moderate complexity or 30–39 minutes. The practical difference is whether the provider managed more than one problem, ordered tests, or prescribed a new medication. Billing 99214 when documentation supports it adds $30–45 per claim over 99213.

Can family practice bill for Chronic Care Management (CPT 99490)?

Yes — and most practices that are eligible aren’t doing it. 99490 applies to Medicare patients with two or more chronic conditions where your practice is the designated CCM provider. Setup requires a care plan and patient consent. Once established, billing 99490 monthly for each eligible patient generates $62–70 per patient from Medicare without any additional office visits.

What is the reimbursement for an Annual Wellness Visit?

G0438 (initial AWV) pays $160–185 from Medicare. G0439 (subsequent AWV) pays $110–130. Both are covered at 100% — no patient co-pay or deductible. For a practice with 500+ Medicare patients, a strong AWV program easily adds $50,000–100,000 in annual revenue while simultaneously improving preventive care quality metrics.

How do I bill a preventive visit and a sick visit on the same day?

Bill the preventive code (99385–99397 or G0438/G0439) and the E/M code (99213–99215) on the same date of service. Append modifier 25 to the E/M code. The E/M must address a new or worsening problem that’s separate from the preventive visit, and both services must be documented distinctly in the medical record. Without modifier 25, most payers will bundle and deny the E/M.

What documentation is required for Transitional Care Management?

For 99495 or 99496, document: (1) the discharge date, (2) the date and method of patient/caregiver contact within 2 business days, (3) medication reconciliation completion, and (4) the face-to-face visit within 14 days (99495) or 7 days (99496). All four elements must appear in the chart. Missing any one will result in a claim denial.

How can I find out if my practice is undercoding?

Pull your E/M utilization report for the last 90 days and look at your code distribution. If 99213 makes up more than 60% of your established patient visits and you serve a complex, chronic disease population, you’re likely undercoding. A professional billing audit can compare your distribution to specialty benchmarks and identify exactly where the revenue gap is. Qualigenix offers free billing assessments — contact us at qualigenix.com/contact-us to schedule one.

Family Practice Medical Billing: The 10 Codes That Drive the Most Revenue

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