Internal medicine billing for practices and groups: office visits and the G2211 add-on, annual wellness visits, chronic care management, transitional care after a hospital stay, and the in-office tests and injections that go with them, worked inside the software you already use.
Internal medicine billing turns every adult visit, care-management month and hospital follow-up into a paid claim. Visits are coded from the decision making or time documented, add-ons such as G2211 are used where Medicare allows them, monthly care-management time is counted before it is billed, and unpaid claims are worked until they close.
$773M
in improper Medicare payments to internal medicine in CMS’s 2025 review, a 9.8% improper payment rate
32.9%
of those internal medicine errors were incorrect coding, and another 62.1% were missing or insufficient documentation
Internal medicine claims are built from layers. A visit for three chronic conditions may carry an add-on for ongoing care, sit on the same day as a wellness visit, and fall inside a month of chronic care management or a 30-day transitional care period after discharge. Each layer has its own rules about who can bill it, how often and with which other services.
The layers on one date decide the claim. That is why we check every visit against the patient’s wellness, care-management and hospital follow-up history before the claim goes out, not after one of the layers is denied.
Most internists bill problem visits, preventive care and care management for the same patients across the year. Each follows its own frequency and pairing rules. Here is where each breaks, and what we do about it.
Pays forOffice visits for patients with several chronic conditions, the G2211 add-on for ongoing care, and monthly chronic care management.
Where it breaks
What we do
Pays forThe Welcome to Medicare visit, annual wellness visits, commercial preventive exams and screenings, usually without cost sharing.
Where it breaks
What we do
Pays forTransitional care management in the 30 days after a discharge, and the visits and calls that support it.
Where it breaks
What we do
Transitional care management pays for the 30 days after a patient leaves a hospital, skilled nursing facility or observation stay for home. It has three hard requirements. Someone from the practice must make interactive contact with the patient or caregiver within two business days of discharge, by phone, video, email or in person. The face-to-face visit must happen within 14 days for 99495, which needs at least moderate decision making, or within 7 days for 99496, which needs high decision making. And medications must be reconciled by the date of that visit.
Only one practitioner can bill transitional care for a discharge in the 30-day period. CMS lets the claim go out on the date of the face-to-face visit, rather than at the end of the 30 days, so the dates in the note decide whether it pays.
What we do: when a discharge reaches the practice, we record the date, check that the two-day contact happened and was documented, and schedule the code to the visit timing. Before the claim goes out, we confirm the medication reconciliation and that no other practice has billed the same period.
Adult primary care runs on a short list of codes used many times a day. These are the ones that decide most internal medicine claims, with what each payer checks on them.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 25 with a same-day procedure only when the visit is separate. |
| G2211 | Add-on for ongoing care of a serious or complex condition | Medicare only; with a modifier 25 visit only when the other service is a wellness visit, a vaccine or a Part B preventive service. |
| G0402 | Welcome to Medicare preventive visit | Once, within the first 12 months of Part B coverage. |
| G0438G0439 | Annual wellness visit, first and subsequent | Once every 12 months, no cost sharing; not a physical exam. |
| 99385 to 99397 | Commercial preventive exams by age | Paid by commercial plans under preventive benefits; not covered by Medicare. |
| 9949099439 | Chronic care management, first 20 minutes and each additional 20 | Two or more chronic conditions, consent on file, and the clinical staff time counted per calendar month. |
| 9949599496 | Transitional care management | Contact within two business days, a visit within 14 or 7 days, one practitioner per 30 days. |
| 9949799498 | Advance care planning | Time documented; modifier 33 when done with a wellness visit, so no cost sharing applies. |
| G0444 | Annual depression screening | Billed with the subsequent wellness visit, not with the first one. |
| 9300036415 | ECG with interpretation, and venipuncture | Separately payable when ordered and documented; venipuncture once per encounter. |
A problem visit on the same day as a wellness visit or a procedure, when it is significant and separate. Modifier 25 explained
Waives cost sharing, for example on advance care planning furnished with a wellness visit.
Medicare: the patient signed an Advance Beneficiary Notice for a service that may not be covered.
Medicare: a service expected to be denied, with no signed notice.
Video visits for plans that ask for it; Medicare uses place of service 02 or 10.
A procedure that is normally bundled but was distinct on this date. Our modifier 59 guide
Sources: CMS MLN booklets on transitional care, chronic care management and Medicare wellness visits; CMS transmittal on G2211 with modifier 25 (2025); Medicare Claims Processing Manual, chapter 12 (physician services) and chapter 18 (preventive services). 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 are a hospital-employed group whose billing the hospital handles, you do not need us. 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, visit levels, G2211 and preventive pairings, care-management and transitional care, 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 each payer's authorization and bundling rules and your fee schedules, list patients enrolled in chronic care management and recent discharges, and agree how escalations work. Most practices are live within one to two weeks.
Visits and care-management months are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, add-ons, pairings and care-management minutes checked, 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, site and service line, what was denied and why, authorizations pending, 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.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Billing companies price their work as a share of what they collect, a flat monthly fee or a charge per claim. Internal medicine produces a steady stream of lower-dollar claims, so a share of collections keeps the incentive on getting every visit, add-on and care-management month paid.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What sets your rate is visit volume, how many patients are in care management, your Medicare share and how clean the receivables are when we take them on, which is why we quote it after the free account review.
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, visit levels and add-ons, wellness pairings, care management and transitional care, 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 Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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