Family practice runs on volume and thin margins, which makes complete charge capture the difference between a healthy year and a flat one. This guide covers the services family practices most often deliver and fail to bill in 2026.
The Annual Wellness Visit Plus the Same-Day Problem Visit
A Medicare patient arrives for an AWV (G0438/G0439) and mentions their knee, or needs a medication adjusted. That is two billable services: the wellness visit and a problem-oriented E/M with modifier 25. Most practices bill one. Count AWVs against the eligible Medicare panel, and the percentage of AWVs with a same-day E/M attached. If the second number is near zero, the work is being done and given away.
Transitional Care Management: 99495 and 99496
Staff already call patients within two business days of discharge and schedule the follow-up visit. That sequence, documented correctly, is TCM – and it pays several times an ordinary office visit. The test: TCM claims over twelve months versus the discharges the practice knows about. Most family practices deliver the service on far more patients than they bill.
Chronic Care Management: 99490 and 99439
Twenty minutes per month of non-face-to-face clinical staff time for patients with two or more chronic conditions. Refills, coordination calls, care plan updates – nurses do this whether or not anyone logs the time against a patient. Without the time log, no claim is ever created, and the loss is invisible to every report the billing system can produce.
Pediatric Immunization Administration: 90460 vs 90471
For patients through age 18, when a provider personally counsels the family, each vaccine component bills 90460/90461 at a meaningfully higher rate than generic 90471 administration. A single MMR is three components. Practices default to 90471 because the EHR was mapped that way years ago. The check: the 90460-to-90471 ratio on patients under 19.
Extended Hours: 99050 and 99051
If the practice advertises evening, weekend or walk-in hours, CPT 99051 adds a payable line to visits during regularly scheduled extended hours on many commercial plans. Almost nobody bills it, because the charge workflow was built around daytime visits.
Enrollment Lag on New Providers
A new physician or NP becomes payer-enrolled 60 to 150 days after their start date. In that gap, claims get held into timely-filing risk, billed incident-to incorrectly, or denied and written off. Measure days from provider start date to first paid claim, by payer, for everyone added in the last two years.
What Ties These Together
None of these losses produces a denial. Each is work performed and never billed, or billed below what documentation supports. A denial dashboard cannot see any of them. Paid dollars per work RVU by payer, trended over 24 months, can.
Revenant Care runs billing operations for physician groups. Every report specification in this guide is available via our contact page – usable with or without us.