Internal medicine billing services for primary care and family practice
Internal medicine billing services cover more than office visits. Internists, primary care groups and family practices bill annual wellness visits, chronic care management, transitional care after discharge and remote monitoring, each with its own timing and documentation rules. Most of these practices also see a large share of Medicare and Medicare Advantage patients.
Fastora provides primary care billing services and family practice billing services inside your existing EHR, with certified billers and coders reviewing each claim. The work builds on our core medical billing services: eligibility, coding, claim submission, payment posting and follow-up.
Eligibility, referrals and annual plan changes
Plan changes take effect each January, so we re-verify coverage at the first visit of the year and confirm primary care assignment for HMO plans that require it. Patients who moved from traditional Medicare to a Medicare Advantage plan often still present the old Medicare card, so both the plan card and the eligibility response are checked through our eligibility verification step.
HMO and some Medicare Advantage plans require a primary care referral before specialist visits, and internists often start authorization for imaging and specialty drugs. Referral and authorization numbers are logged so the downstream claim is not denied.
Codes and rules specific to primary care billing
Primary care billing relies on a set of Medicare codes with frequency, consent and time rules. The table summarizes the main ones; check each commercial payer's policy, since coverage of these services varies outside Medicare.
| Code | Descriptor (summary) | Key rule |
|---|---|---|
| G0402 | Initial preventive physical examination (IPPE) | Within the first 12 months of Part B coverage |
| G0438 / G0439 | Annual wellness visit: initial / subsequent | Once in a 12-month period, and not within 12 months of an IPPE |
| 99490 / 99439 | Chronic care management by clinical staff: first 20 minutes / each additional 20 minutes per calendar month | Two or more chronic conditions expected to last at least 12 months; consent and care plan |
| 99491 / 99437 | Chronic care management by a physician or other qualified professional: first 30 minutes / each additional 30 minutes | Same eligibility; only one practitioner bills CCM per month |
| 99487 / 99489 | Complex chronic care management: first 60 minutes / each additional 30 minutes | Moderate or high complexity decision making |
| 99495 / 99496 | Transitional care management with moderate / high complexity decision making | Contact within 2 business days; visit within 14 / 7 calendar days of discharge |
| 99453 / 99454 / 99445 | Remote physiologic monitoring: setup and education / device supply, 16–30 days / device supply, 2–15 days | Only one device supply code per monitoring period |
| 99457 / 99458 / 99470 | Remote monitoring treatment management: first 20 minutes / each additional 20 minutes / first 10 minutes | Practitioner or clinical staff time in a calendar month |
| G2211 | Add-on for visit complexity tied to ongoing longitudinal care | Medicare limits it when the E/M carries modifier 25 |
Annual wellness visit billing
Annual wellness visit billing fails most often on frequency. Medicare pays G0438 or G0439 once in a 12-month period, and an AWV cannot follow an IPPE within 12 months. Medicare does not apply a copay or deductible to the AWV itself, but a problem addressed at the same visit is a separate E/M service billed with modifier 25 and may carry cost sharing, which patients should hear about at the visit. Advance care planning added to the AWV is reported with modifier 33 so cost sharing is waived.
Chronic care management billing
Chronic care management billing needs a documented initiating visit for new CCM patients, the patient's written or verbal consent, an electronic comprehensive care plan and round-the-clock access to a practitioner. Minutes are tracked per calendar month, and only one practitioner can bill CCM for a patient in a month. Medicare also lists principal care management (99424–99427) for one serious condition and advanced primary care management codes (G0556–G0558), which have their own requirements.
Transitional care management billing
Transitional care management billing covers a 30-day period that starts on the discharge date. The practice must contact the patient or caregiver within 2 business days and see the patient within 14 days for 99495 or 7 days for 99496. Only one practitioner can report TCM for the period, so the discharge date, contact attempts and visit date all need to be in the chart before the claim goes out.
Remote patient monitoring billing
Remote patient monitoring billing separates device setup, the days of data the device transmits and the time spent managing treatment. For 2026, CMS added codes for 2–15 days of data and for the first 10 minutes of management in a month. We track device days and minutes monthly so the right code is selected and the 2–15 day and 16–30 day codes are not both billed for one period.
Documentation that supports internal medicine billing
- Consent for CCM or RPM, with the date and how it was obtained
- A current care plan and the monthly minutes, with who performed the work
- Discharge date, the 2-business-day contact and the face-to-face visit date for TCM
- Device type and the number of days with readings for each RPM period
- Separate assessment and plan for any problem treated at a wellness visit
- The ongoing condition that supports G2211 when it is reported
Common denials and how we prevent them
Most internal medicine billing denials come from timing and overlap. Wellness visits billed too early are denied for frequency, and two practices billing CCM or TCM for the same patient and month leads to one denial. Medicare Advantage plans may apply their own edits, so denials are checked against the plan's policy.
| Denial pattern | Prevention step |
|---|---|
| AWV within 12 months of the last AWV or IPPE | Check the prior visit date in the eligibility response before scheduling |
| CCM or TCM already billed by another practitioner | Confirm with the patient and hold the claim for review |
| Care management time below the code's threshold | Total monthly minutes before the code is selected |
| G2211 with a modifier 25 visit | Apply Medicare's current G2211 rules during claim review |
| Missed Medigap or Medicaid crossover | Confirm crossover on the Medicare remittance and bill the secondary directly when needed |
An advance beneficiary notice matters only for services Medicare may deny as not reasonable and necessary, not for statutorily excluded services. Denied claims are appealed through our denial management workflow, and unpaid secondary balances are worked by our insurance follow-up team.
Credentialing for internal medicine and primary care
New physicians, nurse practitioners and physician assistants need Medicare enrollment, Medicare Advantage and commercial panel participation, and in Texas, Medicaid enrollment through TMHP if the practice sees Medicaid patients. Fastora tracks each application through a nine-stage process, from document collection and CAQH setup to payer applications, follow-ups and final approval, so visits are not delayed or billed before an effective date.
How Fastora works with your practice
Each practice has a dedicated account contact, a transparent dashboard and a monthly review call covering denials, care management claims and AR by payer. We sign a Business Associate Agreement before accessing PHI and work under the user access your practice grants. A free billing assessment reviews a sample of your claims before you commit to anything, and pricing is quoted after that review.
Primary care teams coordinating post-acute and facility-based care can compare home health and hospice billing, neurology billing and oncology billing where referral and drug-benefit rules overlap.
Family physicians in the same group follow the same wellness, chronic-care and crossover rules, which is why family practice billing services and internal medicine billing are handled as one service line here. Independently owned groups can also compare medical billing for small practices.
Referrals between primary care and testing-heavy specialties are common; see allergy and immunology billing and urology billing for the receiving side.
Internal medicine billing and coding
Internal medicine billing and coding covers the full range of an adult practice: preventive visits, chronic care management, transitional care, and the procedures an IM office performs in-house. Internal medicine medical billing means tracking which payer covers which preventive service, keeping chronic-care time documented to the month, and coding the evaluation-and-management levels the note actually supports. Because IM panels are large and visit types vary, charge capture has to be daily — the highest-volume practices lose the most to uncaptured charges. Our medical coding service reviews E/M levels and chronic-care documentation.
Choosing an internal medicine billing company
An internal medicine billing company should show daily workflows for high claim volume — not just specialty knowledge. Ask how they keep up with charge entry at your visit volume, how preventive-versus-problem visit denials are worked, and what the monthly report shows by provider. An internal medicine billing services company that cannot describe its own turnaround times is not ready for IM volume. Practices that outsource internal medicine billing usually hand off claims, denials, and A/R first, keeping scheduling and the front desk in-house. Our A/R management service works the aging and our credentialing and enrollment team keeps new providers billable.