Internal Medicine billing
Primary-care economics live and die on E/M leveling, AWVs, and chronic-care management — three places most billers leave money behind.
Most IM practices we onboard discover they had been giving away $200K–$500K a year just in unbilled AWV and CCM revenue.
Where revenue leaks
The internal medicine traps we see most
Patterns we run into across IM practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
Habitually under-coded 99214s
Many IM practices default to 99213 even when documentation supports 99214 under 2021 MDM rules. The delta is ~$40 per visit. On a 25-visit-per-day panel, that's $250K+ per year of legitimately billable revenue lost.
Missed Annual Wellness Visits
Medicare pays G0438 (~$170) for the initial AWV and G0439 (~$130) for subsequent. Both can be billed alongside a problem-focused visit (with modifier 25). Most practices either skip them entirely or fail to add the problem visit.
Untouched chronic-care management
99490 (CCM) pays ~$60/month per Medicare patient with 2+ chronic conditions. A 1,500-Medicare-panel practice with 60% qualifying patients is leaving $650K+ per year on the table by not running a CCM workflow.
Transitional Care Management forgotten
99495/99496 pays $200–$280 for the post-discharge follow-up most IM practices already do — but only if billed within the right windows (7 or 14 days) with the right documentation.
Coding focus
Where our coders specialize
- E/M codes 99202–99205 (new) and 99212–99215 (established) under 2021 MDM rules
- Annual Wellness Visit (G0438, G0439) + problem visit (modifier 25)
- Chronic Care Management (99490, 99491, 99487, 99489)
- Transitional Care Management (99495, 99496)
- Advance Care Planning (99497, 99498)
- Preventive screenings (G0444 depression, G0442 alcohol, G0102 prostate)
Texas payer notes
Local rules we navigate every day
- BCBS TX often denies modifier 25 unless documentation explicitly separates the wellness vs. problem encounter
- Texas Medicaid (Superior, Amerigroup, UnitedHealthcare CHIP) requires HEDIS-aligned diagnosis specificity
- Medicare Advantage plans (Humana, Aetna, Cigna, WellCare in TX) handle CCM consent forms differently — get them right at intake
IM KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for internal medicine.
3.7
Avg E/M level (target: 3.6+)
85%+
AWV completion rate
60%+
CCM enrollment of qualifying panel
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Other specialties we serve