Family practice billing for solo and group practices: preventive and sick visits on the same day, Medicare wellness visits and care management, vaccines, and Medicaid and commercial plans for every age, worked inside the software you already use by a US-based team.
Family practice billing services turn every kind of primary care visit into a paid claim. Coverage and preventive benefits are checked before the patient is seen, each visit is coded to what the note documents, preventive and problem-oriented care are billed the way each payer wants them, and every payment, denial and patient balance is followed until it is resolved.
$417M
in improper Medicare payments to family practices in CMS’s 2025 review, a 7.6% improper payment rate
68.1%
of those family practice errors were insufficient documentation, and another 17.5% were incorrect coding
Family medicine bills more kinds of visits than almost any other specialty. A child’s well visit, a Medicare wellness visit, a diabetes follow-up and a same-day sick visit can all happen before lunch, and each one has its own codes, its own cost-sharing rules and its own way to fail. When a preventive visit turns into a problem visit, the claim has to show both, or the practice is paid for one.
Most family practice errors start in the note. That is why our billing starts there: when a note does not support the visit level or the second service, we tell you before the claim goes out, not after it is denied.
A family practice bills preventive care, Medicare’s own wellness and care management services, and Medicaid and commercial plans across every age group, often in the same session. Each one pays differently and fails in its own way. Here is where each breaks, and what we do about it.
Pays forPreventive visits with no cost share under most plans, and problem-oriented visits under the patient’s normal copay or deductible.
Where it breaks
What we do
Pays forAnnual wellness visits, the Welcome to Medicare visit, advance care planning, chronic care management and transitional care, each with its own rules.
Where it breaks
What we do
Pays forWell-child visits, vaccines and adult care, under each state’s Medicaid rules and each commercial plan’s own edits.
Where it breaks
What we do
When a patient comes in for a physical and a new or worsening problem is handled in the same visit, both services can be billed: the preventive visit, and an office visit for the problem with modifier 25. The problem visit has to be significant and separately documented. An insignificant or trivial problem that needs no extra work is part of the preventive visit and is not billed on its own.
Medicare follows the same idea for its annual wellness visit: an office visit for a separate problem can be billed the same day with modifier 25, and since January 2025 Medicare allows the G2211 add-on on that visit when the practice has an ongoing relationship with the patient.
What we do: when a preventive visit and a problem visit are billed together, we check that the note documents the problem work separately before the claim goes out. If it does not, we tell you the same day, rather than send a claim that will be bundled or audited.
These are the codes behind most family practice claims, and what payers look for on each one. Medicare’s rules are marked; Medicaid and commercial plans often differ, and we check each plan’s own policy.
| Code | What it covers | What payers look for |
|---|---|---|
| 99381 to 9938799391 to 99397 | Preventive visits, new and established, by age | The age band and new or established status match the patient.MedicareRoutine physicals are not covered; the wellness visit is a different service. |
| 99202 to 99215 | Office visits for problems (E/M) | The level matches the decision making or total time documented. With a preventive visit the same day, modifier 25 and separate documentation. |
| G0402 | Welcome to Medicare preventive visit | Once, within the first 12 months of Part B coverage.MedicareMedicare only. |
| G0438G0439 | Annual wellness visit, initial and subsequent | A health risk assessment and prevention plan, once every 12 months.MedicareNot a physical exam. |
| 99497 | Advance care planning, first 30 minutes | The time and the discussion documented.MedicareNo cost share when billed with the wellness visit and modifier 33. |
| 99490 | Chronic care management, first 20 minutes per month | Two or more chronic conditions, a care plan, patient consent and the clinical staff minutes for the month. |
| 9949599496 | Transitional care management after discharge | Contact within two business days of discharge, and a face-to-face visit within 14 days (99495) or 7 days (99496). |
| G2211 | Office visit complexity add-on | Added to an office visit that is part of ongoing, longitudinal care.MedicareSince 2025, allowed with modifier 25 when the other service is a wellness visit, vaccine or preventive service. |
| 9047190472 | Vaccine administration, first and each additional | Billed with the vaccine product code. For patients through 18 with counseling, 90460 and 90461 apply instead. |
| G0444 | Annual depression screening | Up to 15 minutes, once a year, in a primary care setting.MedicareMedicare only. |
| 96127 | Brief emotional or behavioral assessment | A standardized instrument, scored and documented, billed per instrument. |
An office visit for a significant, separately documented problem on the same day as a preventive visit or procedure. Modifier 25 explained
Tells a plan the service is preventive under the ACA so no cost share applies, and waives Medicare's cost share on advance care planning with the wellness visit.
A synchronous audio-video visit, where the payer requires the modifier.
Routine physicals and other services Medicare never covers, sent when a secondary plan needs Medicare's denial first.
Medicare is expected to deny a service as not medically necessary, such as a screening done more often than covered, and the patient signed an ABN beforehand.
A procedure that is separate from another one billed the same day, used only when the documentation shows it. Our modifier 59 guide
Sources: CPT Evaluation and Management guidelines; Medicare Claims Processing Manual, chapter 12 (physician services) and chapter 18 (preventive services); CMS CY 2025 Physician Fee Schedule final rule summary. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you run a direct primary care practice that does not bill insurance, you do not need a billing service. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, preventive visits billed without the problem visit, Medicare wellness and care management services not billed, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load your payer rules and fee schedules, set up eligibility checks for your schedule, and agree how escalations work. Most practices are live within one to two weeks.
Visits are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, preventive and problem visits split correctly, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, what was denied and why, which preventive and care management services were billed, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
2%
Average claim rejection rate
24 hrs
Claims submitted within
28
Average days in A/R
I manage a medical practice and have worked with Summit Billing Solutions. I have been completely impressed with their professionalism and attention to detail. The staff is highly skilled and have a positive attitude.
Working with their team has been a pleasure as they consistently demonstrate strong problem-solving skills and communicate promptly and clearly.
Most billing companies charge a percentage of what they collect; some charge a flat monthly fee or a per-claim rate. For a family practice, a percentage usually fits best: the company is paid when you are paid, so the incentive sits where it belongs.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What moves the number for a family practice is visit volume, the mix of Medicare, Medicaid and commercial patients, and how clean the receivables are when we take them on, which is why we quote your exact rate after the free account review, not before.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, preventive and wellness services that were not billed, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Drive, Salem, NH 03079
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
They are knowledgeable and detailed with their methods to ensure claims are paid. They are not quick to write off claims. They put the effort into finding the problem or solution it takes to resolve denied or rejected claims.