Internal medicine billing
E/M levels, add-ons and monthly care management, billed the way Medicare reads them.
We bill internal medicine to Medicare’s rules: E/M levels backed by decision making or time, G2211 where the relationship supports it, wellness visits on schedule, and the monthly care management codes most practices leave unbilled.
- Full-service rate
- 3% to 6% of collections
- Medicare focus
- E/M, G2211, AWV, CCM, TCM
- New for 2026
- G2211 home visits, APCM add-ons
- New & smaller practices
- Flexible monthly minimum
What makes internal medicine billing different
Internal medicine practices see many older adults on Medicare, often with more than one chronic condition. The visit is only part of the revenue: Medicare also pays for the work between visits, through chronic care management, transitional care after a hospital stay, and a monthly advanced primary care bundle.
Each of those codes has its own time threshold, consent rule and same-month conflict, and the E/M level underneath has to hold up on review. We check all of it before the claim goes out, as part of our full revenue cycle service at 3% to 6% of collections.
The Medicare codes behind an internal medicine practice
Medicare rules from CMS, with 2026 changes. Medicare Advantage and commercial plans can differ.
- 99202 to 99215Office visits, leveled by medical decision making or by total time on the date of the visit.
- G2211Add-on for being the patient’s continuing focal point for care. From 2026, also with home or residence visits.
- G0438, G0439Annual wellness visit, first and subsequent. Once in 12 months, never within 12 months of the IPPE.
- 99497, 99498Advance care planning, 16 minutes or more. No cost sharing with the AWV and modifier 33.
- 99490, 99439, 99491Chronic care management, two or more chronic conditions: 20 staff minutes, or 30 of the physician’s, a month.
- 99424 to 99427Principal care management for one high-risk condition, 30 minutes or more a month.
- 99495, 99496Transitional care management: contact within 2 business days, a visit within 14 or 7 days.
- G0556 to G0558Advanced primary care management, once a month by complexity, with no minutes to count.
E/M levels and the G2211 add-on
Medicare lets you pick the office visit level by medical decision making or by total time on the date of service. History and exam must be medically appropriate but no longer set the level. Billed by time, CMS’s E/M services guide requires the full time, with no midpoint rounding: 99215 covers 40 to 54 minutes, and prolonged code G2212 starts at 69.
G2211 pays for the load of being the patient’s continuing focal point for care, which fits most internal medicine visits, but not a one-off problem such as a simple virus. Per CMS’s G2211 FAQ, Medicare denies it when the E/M carries modifier 25, unless the other service that day is an annual wellness visit, a vaccine administration or another Part B preventive service. Coinsurance applies, it can be billed in a care management month, and since January 1, 2026 it also goes with home or residence visits.
Annual wellness visits and advance care planning
The annual wellness visit (G0438 the first time, G0439 after) builds a prevention plan: a health risk assessment, a cognitive check, depression and fall risk, and a written screening schedule. Under the CMS AWV rules, it is billable once in a 12-month period and never within 12 months of the IPPE (G0402); early claims deny as a benefit maximum reached. A problem treated at the same visit is billed as an office visit with modifier 25.
Advance care planning is an optional part of the AWV. Given the same day by the same provider, with modifier 33 on the same claim, Medicare waives the deductible and coinsurance once a year. CMS’s ACP fact sheet sets the time: 16 to 45 minutes is one unit of 99497, 46 to 75 adds 99498, and 15 minutes or less is billed as an E/M instead.
CCM, PCM, TCM and APCM: the monthly codes
Chronic care management covers two or more chronic conditions expected to last at least 12 months that put the patient at significant risk of death, decompensation or functional decline. The CMS CCM booklet requires documented consent (verbal is fine), an initiating visit for patients not seen in the past year, and an electronic care plan. 99490 is the first 20 minutes of staff time in a calendar month and 99439 each further 20. Principal care management (99424 to 99427) is the one-condition version.
Transitional care management runs 30 days from discharge. The CMS TCM page requires contact within 2 business days, medication reconciliation by the face-to-face visit, and that visit within 14 days for 99495 or 7 days for 99496. Only one practitioner can bill it.
Advanced primary care management (G0556 to G0558) folds these into one monthly code with no minutes, but requires 24/7 access, a shared care plan and quality reporting. From 2026, add-ons G0568, G0569 (collaborative care) and G0570 (general behavioral health integration) go with it. As the AAFP notes, one clinician cannot bill APCM with CCM or TCM for a patient in the same month, so we pick the code that fits each patient’s month.
Why internal medicine claims deny
Common reasons, with the reason codes that often carry them (codes vary by payer):
- An AWV within 12 months of the last AWV or the IPPE (CO-119)
- G2211, G2212 or 99439 with no base code on the claim (CO-107)
- Two monthly codes that cannot go together, such as APCM and CCM (CO-97)
- TCM already paid to another practice for that discharge (CO-B13)
- A Medicare Advantage patient billed to Original Medicare (CO-109)
- A clinician not yet enrolled with Medicare or the plan on the date of service (CO-B7)
Each goes through our denial management process, and our denial code guides explain what each code means.
How we run internal medicine billing
Check coverage first
Original Medicare or Medicare Advantage, secondary coverage, and the last AWV and IPPE dates are checked for each patient.
Code the visit from the note
The E/M level is matched to MDM or documented time, and G2211, G2212 and modifier 25 are checked against Medicare’s rules.
Track the monthly codes
Consent, minutes, care plans and TCM deadlines are tracked per patient, per month.
Work every denial
Denials are sorted by payer and reason code, then corrected or appealed inside the payer’s deadline.
Report monthly
Collections, days in A/R, denials by reason and care management revenue, by payer and by provider.
Credentialing for internists
Internists enroll with Medicare through PECOS, then each Medicare Advantage plan credentials them on its own. Under 42 CFR 422.204, an MA plan verifies licensure and Medicare payment eligibility from primary sources and recredentials at least every 3 years. Our provider credentialing service handles both at $189 per payer application, $150 per payer for up to 7 payers and $120 per payer for up to 20, with no setup fees.
What changes for these providers, step by step: see nurse practitioner credentialing.
Internal medicine billing questions
Something else? Call +1 786-788-7313. A biller answers.
All questionsG2211 is a Medicare add-on to office visits, and since 2026 to home or residence visits, for a practitioner who is the continuing focal point of a patient’s care or manages a serious or complex condition over time. It is not for a one-off problem, and with modifier 25 it is paid only next to an AWV, a vaccine or another preventive service.
Yes. When you treat a problem at the AWV, bill the office visit (99202 to 99215) with modifier 25 next to G0438 or G0439. The problem portion must be medically necessary, and the usual coinsurance applies to it. G2211 can still be paid on that visit, because the other service is an AWV.
Once in a 12-month period: G0438 for the first AWV and G0439 for each one after. Neither can be billed within 12 months of the Welcome to Medicare visit (G0402), and early claims deny as a benefit maximum reached, so we check the last AWV and IPPE dates before the visit is booked.
CCM is time-based: you count staff or physician minutes each month for a patient with two or more chronic conditions. APCM (G0556 to G0558) is one monthly code set by the patient’s complexity, with no minutes to count but with practice-wide duties such as 24/7 access and quality reporting. One clinician cannot bill both for a patient in the same month.
Contact the patient or caregiver within 2 business days of discharge, then see them face to face within 14 days for 99495, or within 7 days for 99496, which also needs high-complexity decision making. The 30-day period starts on the discharge date, and if the visit misses its window, TCM is not billed.
Our full-service rate is 3% to 6% of monthly collections, set by your volume, with no setup or onboarding fees and flexible monthly-minimum plans for new and smaller practices. It covers eligibility checks, prior authorizations, coding, claims, payment posting, denials and A/R follow-up, plus care management tracking. Your exact rate comes after a free A/R review. Our guide to medical billing costs shows how to compare quotes.
Yes. We don’t list our clients on this site, but ask us and we’ll arrange it: with a current client’s permission, we share their contact details so you can hear how we work from them directly.
From our guides
How to calculate days in A/R
The formula with a worked example and a calculator, the benchmarks, why a good average can hide old claims, and the fixes that bring days in A/R down.
How much do medical billing services cost?
The four ways billing companies price their work, the fees that sit outside the rate, and in-house arithmetic built from BLS data, so you can compare quotes on your own numbers.
Send us your last 90 days of Medicare claims.
We’ll review them free and show you where E/M levels, add-ons or care management codes are costing you money.