CMS Physician Fee Schedule
The published Medicare rates and payment rules behind most of the codes on this page.
Internal medicine billing lives or dies on office E/M level selection (99202-99215) under the 2021+ MDM and time rules, modifier 25 with same-day preventive visits and annual wellness, and chronic care management (CCM 99490/99439/99437) time documentation. Add HCC risk-adjustment capture and AWV G0438/G0444 elements, and general billers undercode every visit. MedFactor delivers internal-medicine-specific RCM that protects every E/M level and every minute of CCM time.
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Office E/M Level Selection (2021+ Rules)
New Patient
9920215-29 min
9920330-44 min
9920445-59 min
9920560-74 min
Established
9921210-19 min
9921320-29 min
9921430-39 min
9921540-54 min
0%Clean Claim Rate
0%Denial Reduction
0dDays in A/R
From primary care internal medicine to hospital medicine and chronic-disease management, we tailor billing to the E/M, preventive, and chronic-care coding rules of every internal-medicine practice type.
Primary Care
Office E/M 99202-99215 under 2021+ MDM/time rules, preventive visits 99381-99397, and AWV G0438/G0444 with HCC capture.
Inpatient
Initial hospital care 99221-99223, subsequent 99231-99233, discharge 99238/99239, and TCM 99495/99496 with face-to-face documentation.
Geriatric Care
Annual wellness visits, CCM 99490/99439/99437 time tracking, BHI 99484, and polypharmacy Z79 coding for older adults.
Chronic Disease
Diabetes E10/E11, hypertension I10, CKD N18, and COPD J44 with CCM care-plan documentation and monthly time capture.
Preventive
Preventive medicine 99381-99397, IPPE G0442, Initial AWV G0438, and Annual AWV G0444 with modifier 25 when same-day E/M.
Membership
Concierge retention codes, time-based CCM/BHI billing, and clear separation of membership fees from billable CPT services.
Internal medicine revenue is concentrated in office E/M level selection (99202-99215) under the 2021+ MDM-or-time rules, plus chronic care management (CCM), transitional care management (TCM), and the modifier 25 separately-reportable line when a preventive visit or AWV is billed with a same-day problem-focused E/M. This is where internal medicine practices lose the most revenue.
Under the 2021+ office E/M rules, level is selected by medical decision making (MDM) OR total time on the date of service — and CCM/TCM are time-based add-on tracks that general billers routinely miss.
New Patient — Office E/M
9920215-29 minStraightforward MDM
9920330-44 minLow MDM
9920445-59 minModerate MDM
9920560-74 minHigh MDM
Established Patient — Office E/M
9921210-19 minStraightforward MDM
9921320-29 minLow MDM
9921430-39 minModerate MDM
9921540-54 minHigh MDM
CCM Base (per patient / month)Chronic Care Management — first 20 min/month99490
CCM — additional 20 min (first add-on, up to 2x)Each additional 20 min of care-plan time per month99439
CCM — additional 30 min (subsequent)Each additional 30 min beyond the first add-on99437
TCM — moderate complexity (14-day follow-up)Transitional care management post-discharge, face-to-face99495
TCM — high complexity (7-day follow-up)High-complexity transitional care within 7 days of discharge99496
Modifier 25 — separately reportable E/M with preventive/AWVSame-day problem E/M with preventive 99381-99397 or AWV G0438/G044499381-99397 · G0438 · G0444 · 25
Our focus: We select office E/M levels by the higher of MDM or total time on the date of service (not just face-to-face), document the CCM care plan and capture every billable 20/30-minute increment of care-management time, bill TCM 99495/99496 within the post-discharge window with face-to-face documentation, and append modifier 25 when a problem-focused E/M is separately reported with a preventive or annual wellness visit — preventing both undercoding of 99214/99215 and the denial of legitimately separate E/M work.
Internal medicine billing is governed by the 2021+ office E/M MDM/time rules, modifier 25 with preventive, CCM care-plan documentation, and HCC risk-adjustment capture — areas general billing companies cannot navigate effectively.
Under the 2021+ rules, office E/M 99202-99215 is selected by MDM OR total time — and practices undercode 99214/99215 when time isn’t documented or MDM is underestimated.
Severity
Same-day problem E/M billed with preventive 99381-99397 or AWV G0438/G0444 is denied when modifier 25 isn’t appended — losing the separately reportable E/M.
Severity
Chronic care management 99490 requires an established care plan, patient consent, and 20 min/month of non-face-to-face time — and 99439/99437 add-ons are missed when time isn’t logged.
Severity
Initial AWV (G0438) and Annual AWV (G0444) require a health risk assessment, cognitive assessment, and care-plan elements that, if undocumented, cause the AWV to be denied.
Severity
Hierarchical condition category (HCC) coding drives Medicare Advantage reimbursement, but chronic conditions documented without specificity (e.g. E11 vs E11.65) lose risk-adjusted revenue.
Severity
CCM, BHI (99484), and TCM (99495/99496) are time-based, but practices lack the tracking systems to log every billable minute of care-management time each month.
Severity
Quick reference for the most frequently used codes in internal medicine billing and coding.
CPT / HCPCS
ICD-10 Codes
Modifiers
| Code | Description | Common Use |
|---|---|---|
| 99202 | Office E/M, new patient, straightforward | Low-complexity new visit |
| 99203 | Office E/M, new patient, low MDM | Standard new patient visit |
| 99204 | Office E/M, new patient, moderate MDM | Complex new patient |
| 99214 | Office E/M, established, moderate MDM | Chronic-disease follow-up |
| 99215 | Office E/M, established, high MDM | High-complexity established visit |
| 99381-99387 | Preventive medicine, new patient (by age) | Annual preventive exam |
| 99391-99397 | Preventive medicine, established (by age) | Recurring preventive exam |
| G0438 | Initial Annual Wellness Visit | First Medicare AWV |
| G0444 | Annual Wellness Visit, subsequent | Recurring Medicare AWV |
| 99490 | Chronic Care Management (first 20 min/mo) | CCM base |
| 99439 | CCM, additional 20 min (up to 2x) | CCM add-on |
| 99495 / 99496 | Transitional Care Management (mod / high) | Post-discharge TCM |
| Code | Description | Clinical Context |
|---|---|---|
| E10.x | Type 1 diabetes mellitus | Insulin-dependent diabetes |
| E11.x | Type 2 diabetes mellitus | Chronic disease / HCC |
| I10 | Essential (primary) hypertension | Most common IM diagnosis |
| E78.x | Disorders of lipoprotein metabolism | Hyperlipidemia / statin mgmt |
| N18.x | Chronic kidney disease (stages 1-5) | CKD staging / HCC |
| J45.x | Asthma | Chronic respiratory disease |
| M54.x | Back pain / dorsalgia | Musculoskeletal complaint |
| F32.x | Major depressive disorder | Behavioral health comorbidity |
| Z79.x | Long-term (current) drug use | Long-term medication mgmt |
| Z00.00 | Encounter for general adult medical exam | Preventive visit |
| Modifier | Description | Internal Med Application |
|---|---|---|
| 25 | Significant, separately identifiable E/M same day | Problem E/M with preventive 99381-99397 or AWV G0438/G0444 |
| 24 | Unrelated E/M during postoperative period | Unrelated visit within a surgical global |
| 33 | Preventive service | Preventive screening mandated by ACA |
| GC | Teaching physician service | Resident supervision in academic IM |
| 95 | Synchronous telemedicine (audio + video) | Telehealth office E/M |
| GT | Telemedicine service (legacy) | Some payer telehealth still required |
| GA | ABN on file | Service not reasonable & necessary, patient notified |
| 52 | Reduced service | Service partially reduced at provider discretion |
Comprehensive revenue cycle management designed specifically for internal medicine practices.
Specialty coders select 99202-99215 by the higher of MDM or total time, document time on the date of service, and capture every 99214/99215 legitimately earned.
CCM 99490 care-plan setup, patient consent tracking, and every 20/30-minute add-on (99439/99437) with documented time logs per patient per month.
Preventive 99381-99397, Initial AWV G0438, Annual AWV G0444 with health risk assessment elements and modifier 25 on same-day problem E/M.
Specificity-first ICD-10 coding for chronic conditions (E11.65, N18.3, etc.) to maximize Medicare Advantage risk-adjusted reimbursement.
Modifier 25 appeals, E/M downcode defense with time documentation, CCM care-plan evidence, and HCC specificity corrections.
Real-time dashboards tracking E/M level distribution, CCM enrollment and time capture, AWV completion rate, and HCC capture by provider.
Understanding the most common denial reasons is the first step to preventing them on E/M, preventive, and chronic-care claims.
99214/99215 downcoded to 99213 when total time on the date of service or MDM complexity isn’t documented in the note.
Time-on-date-of-service documentation and MDM element capture supporting the billed 99214/99215 level.
Same-day problem E/M denied as bundled into the preventive visit or AWV when modifier 25 isn’t appended.
Modifier 25 on every separately reportable problem E/M billed with preventive 99381-99397 or AWV G0438/G0444.
99490 denied when the care plan, patient consent, or 20 min/month of non-face-to-face time isn’t documented.
Care-plan setup, consent tracking, and monthly time logs that support 99490 and every 99439/99437 add-on.
G0438/G0444 denied when the health risk assessment, cognitive assessment, or care-plan elements are missing.
AWV element checklist ensuring every G0438/G0444 submission is complete and supported.
Identifying and plugging these common revenue leakage points can significantly improve your practice’s bottom line.
99214/99215 billed as 99213 when total time or MDM supports a higher level.
Same-day problem E/M with preventive/AWV not billed with modifier 25, losing the separate E/M.
Billable CCM 99490 and 99439/99437 minutes never recorded each month.
Chronic conditions coded without specificity, losing Medicare Advantage risk revenue.
See how internal-medicine-specific revenue cycle management transforms your practice’s financial performance.
A structured onboarding process designed to deliver measurable improvements within the first 90 days.
1WEEK 1-2
Review of E/M level distribution, CCM enrollment, AWV completion, HCC capture, and revenue cycle baseline.
2WEEK 3-4
EMR integration, CCM time-tracking setup, dedicated internal-medicine billing team, and payer enrollment verification.
3WEEK 5-8
Full billing with real-time E/M level verification, modifier 25 protocols, and CCM/TCM time capture.
4WEEK 9-12
Performance review against baseline, HCC capture optimization, and documented revenue improvement.
How our internal-medicine-specific approach compares to in-house billing and general medical billing companies.
| Capability | In-House Team | General Billing Co. | MedFactor IM |
|---|---|---|---|
| 2021+ E/M level selection by MDM or time | Inconsistent | ✕ | ✓ |
| Modifier 25 with preventive / AWV | ✕ | ✕ | ✓ |
| CCM 99490 care-plan & time capture | Inconsistent | ✕ | ✓ |
| 99439 / 99437 CCM add-on tracking | ✕ | ✕ | ✓ |
| AWV G0438 / G0444 element compliance | Manual | Partial | ✓ |
| HCC risk-adjustment specificity coding | Inconsistent | Partial | ✓ |
| TCM 99495 / 99496 within discharge window | Manual | Partial | ✓ |
| E/M level distribution reporting | ✕ | ✕ | ✓ |
| Dedicated internal-medicine billing team | ✕ | ✕ | ✓ |
Our team combines deep internal-medicine billing expertise with the technology and processes to deliver consistent, measurable results for primary care, hospital medicine, and chronic-care practices.
Discover exactly where your internal medicine practice is losing revenue. Our no-obligation audit analyzes your E/M level distribution, CCM capture, modifier 25 compliance, and HCC specificity.
Schedule Your Free Audit
20%Average Revenue ImprovementPractices see an average 20% improvement in net collections within the first year.
2 WeeksAudit Completion TimeComplete billing and coding audit delivered within 10 business days.
Real results from internal medicine practices that partnered with MedFactor for specialty revenue cycle management.
$410KRevenue Recovered
Primary Care IM
A primary care internal medicine practice was routinely downcoding 99214/99215 to 99213 and missing modifier 25 on same-day preventive visits. MedFactor implemented time-on-date-of-service documentation and modifier 25 protocols, recovering substantial E/M revenue in seven months.
42%Denial Reduction15dA/R Reduced
$285KAnnual Capture
Hospital Medicine
A hospital-medicine group was not billing TCM 99495/99496 after discharge and under-documenting initial hospital care complexity. MedFactor implemented TCM within the 7-day window and improved initial hospital care level selection, capturing substantial TCM revenue.
$285KAnnual Recovery31%Revenue Increase
+38%Revenue Increase
CCM / Chronic Care
A CCM-heavy chronic-care clinic enrolled patients in CCM but never logged the 20-min monthly time to bill 99490, and missed every 99439/99437 add-on. MedFactor implemented time tracking and care-plan documentation, billing every legitimate CCM minute per patient.
$190KAnnual Savings38%Revenue Increase
No matter where your internal medicine practice operates, our team understands the payer landscape and regulatory requirements in your region.
Deep coding knowledge across Medicare, Medicare Advantage, Medicaid, and commercial payers for internal medicine services.
Annual wellness visit G0438/G0444 and HCC risk-adjustment coding applied correctly across all 50 states.
Risk-adjusted HCC specificity coding aligned with Medicare Advantage payer requirements nationwide.
Chronic care management 99490/99439/99437 enrollment, consent, and time capture for multi-condition panels.
Common questions from internal medicine practices considering MedFactor’s specialty RCM services.
How do you select office E/M levels under the 2021+ guidelines?
Under the 2021+ office E/M guidelines (codes 99202-99215), the level is selected by the higher of medical decision making (MDM) OR total time spent on the date of service — not just face-to-face time. New patient levels run 99202 (15-29 min, straightforward MDM) through 99205 (60-74 min, high MDM), and established patient levels run 99212 (10-19 min) through 99215 (40-54 min, high MDM). Total time includes the provider’s chart review, documentation, order review, and care coordination on the date of service. We document the time and MDM elements that support the highest legitimately billed level, preventing the routine undercoding of 99214/99215.
When is modifier 25 used with preventive visits and AWV?
Modifier 25 is appended to a problem-focused E/M code (e.g. 99202-99215) when a significant, separately identifiable evaluation and management service is performed on the same day as a preventive medicine visit (99381-99397) or an Annual Wellness Visit (G0438 or G0444). Without modifier 25, the problem E/M is denied as bundled into the preventive or wellness service. The key is that the problem-focused work must be separately documented and medically necessary beyond the routine preventive elements. We append modifier 25 whenever a same-day problem E/M is legitimately performed, preserving the separately reportable E/M revenue.
What documentation is required for chronic care management (CCM)?
Chronic care management code 99490 (the base, first 20 minutes per patient per month) requires an established care plan, patient consent, and at least 20 minutes of non-face-to-face care-management time logged during the month. The care plan must include the patient’s chronic conditions, measurable treatment goals, and the practitioners responsible. Add-on 99439 covers each additional 20 minutes (up to twice per month), and 99437 covers each additional 30 minutes beyond that. We set up care plans, capture consent, and log every billable minute of care-management time so 99490 and every 99439/99437 add-on is supported and billed.
What are the elements of an Annual Wellness Visit (AWV)?
The Initial Annual Wellness Visit (G0438) and subsequent Annual Wellness Visits (G0444) require a health risk assessment, medical and family history, measurement of height, weight, blood pressure, cognitive assessment, depression screening, functional and safety assessment, and a written screening plan or schedule. The AWV is not a comprehensive physical exam — it’s a preventive planning service. We use an AWV element checklist to ensure every G0438 and G0444 submission is complete, and we append modifier 25 to a same-day problem E/M when separately identifiable problem-focused work is documented.
How does telehealth coding work with modifiers 95 and GT?
Modifier 95 indicates a synchronous telemedicine service delivered via real-time audio and video, and is appended to the standard office E/M code (99202-99215) when the visit is performed via telehealth. Modifier GT is a legacy telehealth modifier that some payers still require in place of 95. Most payers now require 95, but we verify the payer’s preferred modifier and apply it correctly so telehealth E/M visits are paid at the appropriate rate rather than denied for missing or incorrect telehealth modifiers.
How do you capture HCC risk-adjustment conditions?
Hierarchical condition category (HCC) risk-adjustment drives Medicare Advantage reimbursement, so chronic conditions must be coded to the highest documented specificity each year. For example, type 2 diabetes is coded as E11.65 (with hyperglycemia) rather than E11 (unspecified), CKD as N18.3 (stage 3) rather than N18.9, and heart failure as I50.22 (chronic systolic) rather than I50.9. We audit the encounter documentation for specificity, capture every chronic condition active on the problem list, and re-document conditions annually so the HCC risk score reflects the patient’s true disease burden.
MedFactor applies the same code-level precision across the full practice spectrum. See how we bill these related specialties.
Family Medicine
Geriatrics
Endocrinology
All Specialties →
CPT®, ICD-10, HCPCS, and modifier codes referenced on this page reflect the current code sets and are subject to annual updates — always verify against the current-year fee schedule before submission. KPIs and case-study figures shown are representative benchmarks, not guarantees of individual practice results.
The rules on this page are published somewhere official. These are the ones worth reading yourself.
The published Medicare rates and payment rules behind most of the codes on this page.
The rules governing referrals between a practice and its own ancillary services.
The coding and billing standards body whose credentials most billers and coders hold.
Enforcement guidance on billing compliance, and the arrangements that attract scrutiny.
The procedure-to-procedure and medically unlikely edits behind most bundling denials.
The internal medicine society covering E/M level selection and chronic care documentation.
Your internal medicine practice deserves billing partners who know the 2021+ E/M MDM/time rules, modifier 25 with preventive and AWV, CCM 99490/99439/99437 time capture, and HCC specificity — and code every claim correctly. Let MedFactor show you what specialty RCM can do.
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