What makes family practice billing services different
Family practice billing services cover the widest patient panel in medicine: newborns, school-age children, working adults and older patients, often in the same day. That range means well visits by age, vaccine products with administration codes, sick visits added onto preventive visits, sports physicals, minor procedures and chronic disease follow-ups — each with its own coding rules. Internal medicine billing centers on adult care; family practice has to handle the pediatric and preventive side too. Fastora's certified billing and coding professionals handle these claims for family practices as part of our wider medical billing services.
Because family practices see everyone, they bill nearly every payer type: commercial plans, Medicaid and CHIP for children, Medicare for older adults, and self-pay for uninsured visits. Eligibility has to be checked by patient, by visit and by benefit — a child's vaccine coverage and an adult's preventive coverage follow different rules.
Well visits, sick visits and same-day billing
Well visits are coded by age — new patient 99381 through 99387 and established patient 99391 through 99397 — while sick visits use the office visit codes 99202 through 99215. When a sick problem is addressed during a preventive visit, both can be billed if the note documents a significant, separately identifiable problem, with modifier 25 on the sick visit code.
Sports and camp physicals are preventive services too, but some payers treat them differently from annual well visits, and school forms do not make a visit billable on their own. We confirm each payer's preventive and physical policies during eligibility checks so families are not surprised by the bill.
Vaccine and immunization billing
| Code | Descriptor (summary) | Billing note |
|---|---|---|
| 90460 | Immunization administration with counseling, first component | Counseling by physician or qualified clinician |
| 90461 | Immunization administration with counseling, each additional component | One unit per additional vaccine component |
| 90471 | Immunization administration, no counseling, first vaccine | Used when no counseling is billed |
| 90472 | Immunization administration, no counseling, each additional vaccine | One unit per additional vaccine |
| 90473 | Intranasal or oral immunization administration, first | Route-specific administration codes |
| G0438 | Annual wellness visit, initial | Medicare; G0439 for subsequent years |
Vaccine products are billed separately from administration, and the two must pair correctly: the product code, the administration code and the route all have to agree. Vaccines for Children program stock cannot be billed to Medicaid for the product, though administration may be billable — mixing VFC and private stock on one claim is a classic denial.
Medicare annual wellness visits use G0438 and G0439, not the preventive visit codes, and they are not the same as a physical exam. When a Medicare patient also needs a problem addressed, the sick visit is billed separately with modifier 25 and the note must support both.
Chronic care and preventive counseling
Chronic care management, 99490 and its add-on codes, pays for the non-face-to-face work of managing patients with multiple chronic conditions — but only when the care plan, consent and time are documented. Advance care planning, tobacco cessation counseling (99406 and 99407) and obesity counseling have their own frequency limits by payer.
These services add real revenue for family practices with large chronic-disease panels, but they are also frequent audit targets. We check the documentation elements each payer requires before these codes go out.
Eligibility across a mixed-age panel
We run eligibility and benefits checks before visits, confirming preventive coverage, vaccine benefits, referral requirements and whether the plan treats the practice as primary care. Children's coverage through Medicaid, CHIP or a parent's commercial plan can change mid-year, so we recheck on a schedule rather than assuming the last visit's coverage still holds.
Some services need prior authorization even in primary care — certain imaging, sleep studies and specialty referrals — and the authorization has to name the right servicing provider or the claim follows the patient back.
Common family practice billing denials and how we prevent them
| Denial | Typical cause | Prevention step |
|---|---|---|
| Preventive visit denied | Plan excludes or limits well visits, or wrong age-band code | Preventive benefits confirmed before the visit |
| Sick visit bundled | Modifier 25 missing or no separately documented problem | E/M note reviewed before both codes are billed |
| Vaccine administration denied | Product and administration codes mismatched, or VFC stock billed | Product, route and stock source reconciled per claim |
| CCM denied | Missing consent, care plan or time documentation | CCM documentation checklist completed before billing |
| Well visit billed to Medicare | 99381-99397 used instead of G0438/G0439 | Medicare visits coded to the AWV codes |
Every claim passes our Advanced Pre-Submission Claim Review before submission. Denials that still occur are worked by our denial management team, which corrects and resubmits or appeals with the record, and open balances are followed up by payer and age.
Credentialing for family physicians
Family physicians, pediatric-facing clinicians, nurse practitioners and physician assistants each need enrollment with the plans they bill, and new clinicians need to be linked to the group before their claims pay in network. Medicaid and CHIP enrollment has its own timelines and revalidation cycles.
Our credentialing and enrollment service tracks each file through a nine-stage process, from document collection and NPI and CAQH setup to payer applications, follow-ups and final approval.
How Fastora supports family practice billing
Fastora works inside your existing EHR/PM system under the user access you grant, with no software to install and no hidden setup fees. You get a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call.
Fees are quoted after a free assessment, and you can read how our pricing models work beforehand. To see how your current claims hold up, start with a free billing assessment.
Family practice billing and coding services
Family practice billing and coding covers everything a broad-scope practice does: preventive visits, sick visits, chronic care management, minor procedures and screenings — each with its own coding rules. Our family practice medical billing team checks preventive vs problem-oriented visit coding, tracks chronic care program claims, and keeps modifier use clean on same-day procedures. As a family practice billing company, we also handle the volume reality of primary care: high visit counts mean eligibility and charge entry have to run daily, not weekly. A family practice billing services company that only knows claims will miss the front-end — ours starts at the schedule.
Primary care billing company services — or outsource yours
Primary care billing and coding is the core of what we do: primary care medical billing across family practice, internal medicine and general practice. As a primary care billing company, we manage the full cycle — eligibility verification, coding review, claims, denials and A/R. A primary care billing services company like ours can also run selected pieces: a primary care medical billing company engagement might cover only claims and denials while the practice keeps scheduling. Practices that outsource family practice billing or outsource primary care billing entirely get a dedicated account contact and monthly review, with the same reporting as a full partnership. Related: internal medicine billing, medical billing services, choosing a medical billing company.