Internal Medicine Billing Services
Expert billing for internal medicine practices with deep expertise in chronic care management, Annual Wellness Visits, transitional care, and the complex time-based coding unique to adult primary care.
Adult Primary Care Revenue
Specialized billing for internal medicine practices nationwide
Why Internal Medicine Billing Requires Specialized Knowledge
Internal medicine billing centers on managing chronic conditions over time—diabetes, hypertension, COPD, heart failure, and multiple comorbidities per patient. Unlike other specialties focused on acute episodes or procedures, internists generate revenue through longitudinal care management, preventive services, and time-based billing that most general billers don't fully understand.
The complexity stems from multiple revenue streams beyond office visits. Chronic Care Management (CCM) generates $40-60 per patient per month for practices tracking time spent on care coordination outside of face-to-face visits. Annual Wellness Visits (AWV) pay $150-200 and are completely separate from E/M visits. Transitional Care Management (TCM) pays $150-250 for managing patients discharged from hospitals. Most internal medicine practices leave 30-40% of their potential revenue uncaptured because these services aren't being billed.
Time-based billing adds another layer of complexity. Prolonged service codes (99354, 99355) apply when visits exceed typical time thresholds. Care plan oversight codes (99339, 99340) pay for managing hospice and home health patients. These codes require meticulous time tracking and documentation that most practices don't have systems to capture.
We built our internal medicine billing practice specifically around these chronic care and time-based billing opportunities. Our team understands which patients qualify for CCM, how to document AWV components properly, and how to track time-based services that generate significant revenue without additional face-to-face visits.
Internal Medicine Billing Expertise for Adult Primary Care
Chronic Care Management (CCM)
Patient identification, consent tracking, time logging systems, and monthly billing for CCM (99490), Complex CCM (99487/99489), and Principal Care Management (99424/99425). Maximizing non-face-to-face revenue.
Annual Wellness Visits (AWV)
Complete AWV workflow including health risk assessments, personalized prevention plans, advance care planning, and proper documentation of all required elements. Initial (G0438) and subsequent (G0439) visits.
Transitional Care Management
TCM billing for post-discharge management (99495/99496). Phone contact tracking, face-to-face visit scheduling within required timeframes, and proper documentation of medical decision making complexity.
Complex E/M Optimization
Proper level of service selection for patients with multiple chronic conditions. Medical decision making documentation, time-based billing when appropriate, and prolonged service code usage.
Preventive Care Billing
Preventive visit coding (99385-99387, 99395-99397) paired with problem-oriented E/M when appropriate. Screening service billing, immunizations, and modifier 25 compliance for same-day services.
Value-Based Care Reporting
Quality measure tracking for MIPS, ACO reporting, and risk adjustment coding. Proper HCC coding to accurately reflect patient complexity and maximize capitation payments.
Chronic Care Management: The Most Underutilized Revenue Source
CCM represents one of the largest untapped revenue opportunities in internal medicine. Medicare pays $40-65 per patient per month for non-face-to-face chronic care coordination—yet fewer than 20% of eligible practices bill for it. For a practice with 500 CCM-eligible patients, that's $240k-390k in annual revenue sitting uncollected.
Patient eligibility requirements are straightforward. Patients need 2+ chronic conditions expected to last 12+ months, placing them at significant risk of death, acute exacerbation, or functional decline. This describes most Medicare patients in an internal medicine practice—diabetes, hypertension, COPD, CHF, CKD, and similar conditions all qualify.
Time tracking is the critical component. CCM requires 20 minutes of non-face-to-face care coordination per month. Complex CCM requires 60 minutes. This includes phone calls with patients, care coordination with specialists, medication management, review of test results, and care plan updates. Most practices already do this work—they just don't track and bill for it.
Complex CCM (99487/99489) pays significantly more. For patients requiring moderate to high complexity medical decision making—multiple unstable chronic conditions, recent hospital discharge, complex medication regimens—Complex CCM reimburses $90-120 for the first 60 minutes plus $40-50 for each additional 30 minutes. Practices managing complex patient populations should bill Complex CCM whenever documentation supports it.
Principal Care Management (PCM) is the newer addition. PCM (99424/99425/99426/99427) applies to patients with a single complex chronic condition requiring intensive management. Similar time requirements as CCM, but for patients who don't meet the "2+ conditions" threshold. This expands billable services to additional patients in your panel.
Internal Medicine CPT Codes & Reimbursement
Internal Medicine Billing FAQs
What patients qualify for Chronic Care Management billing?
Patients need 2+ chronic conditions expected to last 12+ months that place them at significant risk. Common qualifying conditions include diabetes, hypertension, COPD, CHF, CKD, CAD, depression, and most other ongoing conditions requiring management. The patient must consent to CCM services, and you must provide at least 20 minutes of non-face-to-face care coordination per month. This includes phone calls, care coordination, medication management, test result review, and care plan updates.
Can I bill CCM and E/M visits in the same month?
Yes. CCM billing is completely separate from E/M visit billing. In fact, time spent during face-to-face E/M visits cannot count toward CCM time—CCM must be non-face-to-face services. You can bill both an office visit (99213-99215) and CCM (99490) for the same patient in the same month, as long as the CCM time is tracked separately from the visit time.
What's the difference between an Annual Wellness Visit and a preventive visit?
AWV (G0438/G0439) is a Medicare-specific benefit focused on creating a personalized prevention plan—it's not a comprehensive physical exam. Preventive visits (99385-99397) are comprehensive age-based exams covered by commercial insurance. AWV includes health risk assessment, cognitive screening, depression screening, advance care planning, and prevention plan review. Many practices schedule AWV and comprehensive exams on different days to capture both services appropriately throughout the year.
How does Transitional Care Management (TCM) work?
TCM (99495/99496) covers post-discharge management for 30 days after hospital or SNF discharge. Requirements include phone contact within 2 business days and a face-to-face visit within 7 days (high complexity) or 14 days (moderate complexity). TCM is billed once per discharge episode and includes all non-face-to-face communication, care coordination, medication reconciliation, and the required follow-up visit. It cannot be billed with CCM in the same month, so practices choose whichever provides higher reimbursement.
When can I use prolonged service codes?
Prolonged service codes (99354/99355) apply when total visit time exceeds the typical time for the E/M code billed. For example, 99215 has a typical time of 40-54 minutes. If your visit takes 80 minutes, you'd bill 99215 plus 99354. Documentation must show actual time spent and medical necessity for the prolonged time. As of 2023, prolonged services can be billed based on total time (including non-face-to-face time on the same date), making it easier to capture additional payment for complex visits.
Stop Missing Internal Medicine Revenue Opportunities
Uncollected CCM, missed AWV opportunities, and unbilled TCM services cost internal medicine practices $70k-250k annually. Let's calculate your exact revenue gap.
Serving internal medicine practices nationwide. Expert billing for CCM, AWV, TCM, and chronic disease management.
A-Z Medical Billing & Consulting was founded by Zain Vally, who identified persistent revenue cycle inefficiencies while operating Vally Medical Group, a multi-location occupational medicine practice across Hawaii. The hands-on experience of managing billing operations for practices spanning multiple islands revealed systematic problems in how most billing services approach time-based and chronic care billing. Our internal medicine expertise comes from years of working with adult primary care practices to implement CCM programs, optimize AWV capture, and maximize time-based service revenue. We built A-Z specifically to address these gaps through systematic prevention, aggressive pursuit of denied claims, and transparent reporting.