Primary care
E&M undercoding. Missed CCM. Absent TCM. It's not small money.
Primary care runs on volume — which makes under-coding compound. A practice billing Level 3 when the documentation supports Level 4, skipping CCM when 40% of the panel qualifies, and missing TCM entirely can leave six figures on the table. We don't miss it.
Who this serves: Independent primary care practices (2–20 providers), concierge practices, and hospital-based primary care departments.
Primary care's financial pain is rarely dramatic. No catastrophic denials. No single-code disasters. Just a slow leak across thousands of encounters where the billed level doesn't match the documented work.
The average primary care practice bills Level 4 E&M for 28–32% of visits. Well-run practices hit 38–45%. The difference — on a practice seeing 25,000 visits a year — is often $200K+.
Add to that the programs that most practices have on paper but don't operationalize: CCM (99490/99439) for the 40% of patients with two or more chronic conditions. TCM (99495/99496) after hospital discharges. AWV (G0438/G0439) for Medicare patients. Each one is a real revenue stream quietly ignored.
What separates a specialty-fluent biller from a generalist.
E&M optimization
- Level 4 capture (99214) with MDM documentation support
- Time-based vs. MDM-based coding — whichever supports the work better
- Provider-specific coaching based on their own coding patterns
- Modifier 25 discipline for preventive + problem-focused visits
Chronic care & wellness
- Chronic Care Management (99490, 99439) — end-to-end program
- Transitional Care Management (99495, 99496)
- Annual Wellness Visit (G0438, G0439) scheduling + coding
- Advance Care Planning (99497, 99498)
Preventive & vaccinations
- Vaccine administration (90471–90474, 90460/90461 for peds)
- Preventive counseling (G0444, G0447)
- Screening E&M vs. problem-focused split billing
Reporting & quality
- MIPS reporting — quality, promoting interoperability, improvement activities
- HCC risk adjustment optimization (for risk-bearing contracts)
- Panel-level chronic-condition reporting
E&M coaching is behavior-change, not billing
We give providers monthly one-pagers showing their own coding distribution — not lectures. Behavior moves.
CCM as a program, not a code
We run the CCM operations end-to-end: eligibility, consent, care coordination, documentation, billing.
CPA-led risk contract support
If you're in value-based contracts, we connect quality reporting to financial upside — not just compliance.
Midwest Primary Care Group — 8 providers, 2 locations, 15,000 patients
28% → 41%
E&M Level 4 capture
+$285K
Annual revenue
$96K
New CCM revenue
91% → 97.2%
Net collection rate
Year one: $285K additional revenue. $189K from E&M optimization. $96K from the new CCM program.
Read the full case studyDays 1–30 · Audit
E&M coding audit across all providers. CCM eligibility analysis. Missed TCM and AWV identified.
Days 31–60 · Coach + launch
Provider coaching installed. CCM program launched. TCM workflow operationalized.
Days 61–90 · Measure
First full month of optimized E&M. First CCM billing. Monthly packet delivered.
Ownership structure doesn’t change the billing mechanics. The practice is the unit we serve.
- Independent primary care practices, solo through multi-location
- Concierge and direct-primary-care practices
- Hospital-based primary care departments
- Pediatrics and internal medicine practices (see also pediatrics page for pediatric-specific billing)
Free audit
Curious how much you're leaving on the table in primary care?
Our free 30-day audit tells you — specific codes, specific payers, specific dollar amounts. No contract. You keep whatever we find.