Primary Care Billing Services | AWV, CCM, Preventive | Quilven RCM
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Specialty · Primary Care

Preventive is revenue. Run it.

The codes pay. G0439 is 120 dollars. The 99214 stacked on top with modifier 25 is another 80. CCM at 62 dollars a month per enrolled patient compounds monthly. The work happens already. The billing is where the cycle leaks.

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AWV completion target on Medicare panel
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Target time to billable for new provider
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Free audit turnaround
The primary care billing problem

Most PC revenue leaks where preventive lives.

A patient walks in for their Medicare wellness visit. The provider runs through the Health Risk Assessment, screens for depression with the PHQ-9, talks to the patient about their A1C, adjusts their lisinopril, and orders labs. The visit gets billed as a G0439. The 99214 problem oriented work, plus modifier 25, plus the depression screening, plus the PHQ-9 instrument fee, plus the lab order administration. All of it sits in the note. None of it makes it to the claim.

That visit should have generated about 250 dollars. It generated 120. The 130 dollar gap, across a panel running roughly 1,500 Medicare patients with 70 percent AWV completion and 40 percent of those visits addressing a problem, is around 55 thousand dollars a year for a single provider. Multiply by a 5 provider group and you are looking at a quarter million dollars walking out the door annually.

CCM is the second leak. About 35 percent of a typical primary care panel meets the eligibility criteria for chronic care management billing. Two or more chronic conditions expected to last 12 or more months. The barrier is operational, not clinical. Somebody has to get written consent, build the care plan in the EHR, log the monthly minutes, and bill 99490. Vendors paid 5 to 8 percent of collections do not run CCM programs. The hours do not pencil out for them.

The third leak is everything else preventive. Tobacco cessation counseling (99406). Alcohol misuse screening (G0442). Advance care planning (99497). Obesity counseling (G0447). All of it gets done during normal primary care visits. Most of it gets written into the visit narrative instead of flagged for billing. The fix is a coder rule and an EHR template prompt. That is the work we do.

The leak, in numbers

Four sliders. Watch preventive revenue.

Pull these numbers from your practice management report. The output is what your panel should be generating in annual wellness visits, modifier 25 stacked E/M, and CCM that most primary care practices leave on the table.

Active panel size
3,000
10015,000
% Medicare in panel
50%
10%90%
Current AWV completion rate
40%
0%100%
% eligible for CCM (2+ chronic conditions)
35%
10%70%
AWV recovery
G0438 and G0439 capture moving from current rate to 70 percent target
$0
Modifier 25 stack
Same day E/M on AWV visits captured with modifier 25
$0
CCM revenue
99490 plus 99439 across eligible patients enrolled at 30 percent
$0
Annual recoverable
$0

Based on CMS national average rates. Your real number is usually larger once preventive screening capture, tobacco cessation, advance care planning, and downcoded 99214s are included. The 48 hour audit gives you the line by line breakdown from your own data.

Side by side

Same primary care practice. Two outcomes.

What a percentage based billing vendor delivers versus what a managed department delivers. The economics drive every decision.

Typical PC billing vendor

Paid for claims submitted. Not collected.

  • AWV completion runs at thirty to fifty percent of the Medicare panel. Outreach not in scope.
  • Same day AWV plus problem visit billed without modifier 25. The E/M denies as bundled.
  • CCM workflow not built. The recurring monthly revenue line item never starts.
  • Preventive screening codes (G0444, G0442, 99406) documented in the narrative but never billed.
  • Immunization administration codes mismatched with product codes. CMS denies the pair.
  • E/M coding accepts the EHR default. 99214 visits go out as 99213 and nobody flags it.
  • First denial appeal sent. Second appeal does not happen because the math does not work for them.
  • Aged AR over ninety days quietly written off after a long enough silent interval.
Quilven · Department model

Paid to own the whole cycle.

  • AWV outreach campaigns built. Target seventy percent completion on Medicare panel.
  • Same day AWV plus E/M routinely stacked with modifier 25. Coder rule audited monthly.
  • CCM program stood up. Consent collected, care plan documented, time logged, billed monthly.
  • Preventive screening codes captured from documentation. G0444, G0442, 99406, 99497 routinely billed.
  • Immunization administration paired correctly with product code. CMS G-codes used for Medicare.
  • Certified coder reviews documentation before submission. 99214s stay 99214s when supported.
  • Denials worked to round three or four when the dollar amount and clinical merit support it.
  • AR over ninety days is the first queue our analysts open in the morning, not the last.
CPT and HCPCS reference

Every code that pays primary care.

Sixty plus codes in primary care scope. Search by number or filter by category. Each card has the fee range, what the code bills for, common denials, and what we look for in the note.

Pick a code above or search by number.
What we cover

Eight functions of PC revenue cycle, under one team.

A managed department, not a claim submission service. Every function below runs under the same operations head, with the same KPIs, reporting into Apex.

FunctionWhat Quilven runsWhat typical vendors do
AWV completion Outreach campaigns built. Target seventy percent of Medicare panel. G0438 versus G0439 sequencing tracked. Whatever the front desk schedules. Thirty to fifty percent completion is normal.
Modifier 25 stacking Same day AWV plus E/M coded with modifier 25 when documentation supports it. About eighty dollars extra per qualifying encounter. Inconsistent. Modifier missing. E/M denied as bundled.
Chronic Care Management Eligible patients identified. Consent collected. Care plan built. Monthly time logged and 99490 plus 99439 billed. Out of scope. The recurring revenue never starts.
Preventive screening capture G0444 depression, G0442 alcohol, 99406 tobacco, 99497 advance care planning captured from documentation. Done by the provider. Documented in the narrative. Never billed.
Immunization coding accuracy Product code plus administration code paired correctly. G0008 G0009 G0010 used for Medicare flu, pneumococcal, hepatitis B. 90471 billed for Medicare flu shots. CMS denies.
E/M coding accuracy Certified coder reviews documentation. 99214 versus 99213 calls made against the note. Bell curve audited monthly. Submits whatever the EHR template defaulted to. Downcoding stays invisible.
Aged AR recovery Claims over ninety days worked first in the queue. Appeals to round three or four when the math justifies it. Aged claims written off. First appeal sent, then silence.
Credentialing CAQH maintained. PECOS revalidations on calendar. Live master sheet. Target ninety days to billable. Status updates by email when asked. Average one hundred twenty to one hundred eighty days.
2 minute self audit

How much is your PC cycle actually leaking?

Eight questions. No email required. The result is written for primary care, with the specific line items leaking based on your answers.

Question 01 of 08
Common questions

Primary care billing, answered straight.

The questions practice administrators actually ask before signing with a billing company.

The best billing service for a primary care practice is one structured around the preventive bundle and the E/M accuracy that drive primary care economics. That means annual wellness visit billing with same day E/M stacking using modifier 25, chronic care management for eligible Medicare patients, preventive screening codes routinely captured rather than left in the visit narrative, immunization administration paired correctly with product codes, and certified coder review on the 99213 versus 99214 decision. Quilven runs all of these as a managed department, not a percentage of collections service.
Typical primary care billing vendors charge 5 to 8 percent of collections. The math is the structural problem. On a G0439 annual wellness visit that pays approximately 120 dollars, the vendor earns six to ten dollars. On a 99490 chronic care management claim paying around 62 dollars, the vendor earns under four. That math drives every decision about which functions to run and which to skip. Vendors paid percentage skip CCM program setup, skip preventive screening capture, skip modifier 25 stacking, and write off aged AR. Quilven uses a managed department pricing model that includes the work percentage based vendors skip.
Primary care bills primarily evaluation and management codes (99202 through 99215), annual wellness visit codes (G0402, G0438, G0439), chronic care management codes (99490, 99439, 99491, 99437, 99487, 99489), principal care management (99424 through 99427), advance care planning (99497, 99498), preventive screening codes (G0444 depression, G0442 alcohol, 99406 tobacco, 96127 PHQ-9 GAD-7, G0447 obesity), immunization administration (90471, 90472, G0008, G0009, G0010) paired with product codes (90686 influenza, 90732 pneumococcal, 90715 Tdap), in office labs (81002, 82962, 87880, 36415), basic procedures (93000 ECG, 94010 spirometry, 20610 joint injection, 11200 skin tag removal), and modifiers (25, 24, 59, 95).
Annual wellness visit billing uses three main HCPCS codes. G0402 is the welcome to Medicare visit, billed once during the first 12 months of Medicare Part B enrollment, paying approximately 165 dollars. G0438 is the initial annual wellness visit, billable starting at month 13 of Medicare, once per lifetime per patient, paying approximately 170 dollars. G0439 is the subsequent annual wellness visit, billed annually thereafter with minimum 11 months between visits, paying approximately 120 dollars. Each AWV requires a Health Risk Assessment, review of preventive services, depression and cognitive screening, and a personalized prevention plan documented in the EHR. Industry leaders complete AWVs on 70 percent or higher of their eligible Medicare panel. Most practices complete 30 to 50 percent.
G0438 and G0439 are both Medicare Annual Wellness Visit codes. The difference is sequencing. G0438 is the initial AWV, billed once per lifetime per patient, used at the first AWV after the patient has been enrolled in Medicare Part B for at least 12 months. Pays approximately 170 dollars. G0439 is the subsequent AWV, used every year thereafter with minimum 11 months between visits. Pays approximately 120 dollars. A common error is billing G0438 in year 2 instead of year 1. Another common error is billing G0438 within the first 12 months of Medicare when G0402 (welcome to Medicare) was the correct code. Both errors trigger denials and require resubmission.
Yes. An annual wellness visit (G0438 or G0439) can be billed on the same day as a problem oriented E/M visit (such as 99214) when both services are documented separately. Modifier 25 must be appended to the E/M code to identify it as significant and separately identifiable from the AWV. Without modifier 25, the E/M is denied as bundled. Done correctly, the same day stack adds approximately 80 dollars per qualifying encounter. Across a primary care panel running 70 percent AWV completion on Medicare patients with 40 percent of those visits also addressing a problem, the missed modifier 25 stack costs a typical 3 provider primary care practice 40 thousand to 60 thousand dollars per year.
Preventive services in family medicine are billed under a cluster of HCPCS and CPT codes that get documented constantly and billed inconsistently. G0444 covers annual depression screening up to 15 minutes (PHQ-9 is the standard tool). G0442 covers annual alcohol misuse screening (AUDIT or AUDIT-C). 99406 and 99407 cover tobacco cessation counseling, up to 8 sessions per year. 96127 covers brief emotional and behavioral assessment per standardized instrument. G0447 covers individual obesity behavioral counseling. The screening and counseling happen during normal primary care visits, but the codes routinely fail to make it onto the claim because the work is documented in the visit narrative rather than flagged for billing. A typical primary care practice underbills preventive services by 30 to 50 percent. The fix is a coder rule and an EHR template prompt, not new clinical work.
Industry average for primary care provider credentialing is 120 to 180 days from start to billable. Vendors that treat credentialing as a side task often run longer. Quilven targets 90 days to billable through a live master sheet visible to the practice, weekly payer follow ups, dedicated enrollment leads on CAQH and PECOS, and proactive revalidation tracking. Every month a new primary care provider is not billable costs the practice approximately 30 thousand to 45 thousand dollars in lost revenue depending on panel size and payer mix.
Quilven offers a free 48 hour billing audit with no commitment for primary care practices. The practice sends 90 days of claims data. Within 48 hours, Quilven returns a line by line breakdown showing what is recoverable by CPT code, by payer, and by month. Common findings in primary care include 99214 visits downcoded as 99213, AWV plus same day E/M stacks unbilled (missed modifier 25), preventive screening codes documented but never claimed, CCM eligible patients never enrolled, immunization administration codes mismatched with product codes, and aged AR written off prematurely. The audit is delivered as a PDF report and a 30 minute review call. The practice keeps the findings whether or not they engage Quilven for managed RCM services.
Typical primary care billing companies are paid 5 to 8 percent of collections. The economic model means they prioritize easy claims, write off aged AR, skip CCM program setup, skip preventive screening capture, and apply modifier 25 inconsistently because the per claim revenue does not justify the per claim work. Quilven operates as a managed department with a flat operational model that includes the work percentage based vendors skip. Practices get certified coder review on E/M, AWV plus E/M stacking with proper modifier 25 handling, CCM program setup and monthly billing, preventive screening capture from the visit narrative, immunization administration accuracy, denial recovery to round three or four, aged AR worked first in the morning queue, and live dashboard reporting through the Quilven Apex platform.
About Quilven

The billing department for primary care.

Quilven is a managed revenue cycle management company based in Nashville, Tennessee. We provide end to end medical billing services for primary care practices, family medicine groups, internal medicine practices, behavioral health practices, and community hospitals across the United States.

The company runs a managed department model rather than a percentage of collections billing service. The structural reason matters. Vendors paid 5 to 8 percent of collections optimize for high dollar, easy to clear claims. They skip the work that does not pay them, which in primary care is most of the preventive revenue. That includes annual wellness visit completion outreach, modifier 25 stacking on same day AWV plus E/M, chronic care management for eligible Medicare patients, preventive screening capture from the visit narrative, immunization coding accuracy, and aged AR over 90 days.

Primary care billing under the Quilven model includes certified coder review on E/M coding (99202 through 99215), AWV outreach campaigns targeting 70 percent completion on the Medicare panel, modifier 25 audit on same day AWV plus problem visits, CCM program setup with consent collection and time tracking, preventive screening code capture from documentation (G0444 depression, G0442 alcohol, 99406 tobacco, 99497 advance care planning, G0447 obesity), immunization administration paired correctly with product codes, denial recovery to round three or four when the dollar amount supports it, aged AR worked first in the morning queue, and provider credentialing managed against a target of 90 days to billable.

The company is HIPAA compliant. Business Associate Agreements are available on request. Quilven works with practices on any EHR platform including eClinicalWorks, NextGen, AdvancedMD, Athenahealth, Epic, Cerner, Greenway, and Practice Fusion.

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