Understand Primary Care CPT Codes – A Comprehensive Guide
Category I CPT codes dominate primary care billing.
- Chronic care & telehealth expansion are major 2025 updates.
- Always document time, BMI, and comorbidities for compliance.
- Use cheat sheets to simplify coding for family practice, internal medicine, and urgent care.
- Accurate coding = fewer denials + higher reimbursement.
Primary Care Codes are the backbone of accurate medical billing. They ensure providers are reimbursed correctly while maintaining compliance with payer rules. With 2025 bringing critical CPT code updates, it’s more important than ever for primary care providers to stay current.
This guide, developed by certified medical coders and physicians at ExpressMBS.
2025 Primary Care CPT Code Updates
Stay ahead with these key changes effective January 1, 2025:
- New Chronic Care Management Code (99491):
- Replaces 99487 for patients with multiple chronic conditions.
- Requires 60+ minutes of medical staff time/month.
- Telehealth Expansion (99421-99423):
- New codes for asynchronous (store-and-forward) telehealth visits.
- Covers follow-ups for stable chronic conditions (e.g., hypertension, diabetes).
- Preventive Services (99381-99397):
- Revised age-specific guidelines for pediatric and adult wellness visits.
- Additional attention for obesity counseling (BMI ≥30).
- Behavioral Health Integration (G2211):
- Use for coordinating mental health care during routine visits (e.g., depression screening).
- Prolonged Services (99417):
- Requires 15+ minutes beyond the primary E/M code (99205/99215).
- New Chronic Care Management Code (99491):
CPT codes are divided into three categories
Primary care CPT Codes fall into three categories:
- Category I Codes – Most common, covering office visits, preventive services, vaccines, and procedures.
- Category II Codes – Optional codes for performance measurement (quality reporting).
- Category III Codes – Temporary codes for emerging technologies.
For primary care providers, Category I codes are most relevant, as they cover everyday patient visits, lab work, preventive exams, and chronic care management.
Top 10 Primary Care CPT Codes for 2025 (Cheat Sheet)
CPT Code | Description | Use Case |
99213 | Established patient visit (low complexity) | Mild illness (UTI, cold). |
99214 | Chronic disease management (diabetes, HTN). | |
99396 | Preventive visit (age 40–64) | Annual checkup + screenings. |
99483 | Cognitive assessment | Dementia or cognitive decline evaluation. |
99421 | Asynchronous telehealth visit | Reviewing labs, e-prescriptions. |
G2211 | Behavioral health integration | Anxiety/depression with primary care visit. |
90471 | Vaccine administration | Flu shots, COVID boosters. |
99202 | New patient visit (low complexity) | Initial primary care evaluation. |
99417 | Prolonged services | Extended counseling or smoking cessation. |
99491 | Chronic care management | Ongoing care for 2+ chronic illnesses. |
Avoid These 5 Common Billing Mistakes
- Under coding Prolonged Services:
- Example: Billing 99214 without 99417 for a 45-minute visit.
- Fix: Track time and append modifier 25 if needed.
- Mismatching Modifiers:
- Example: Using modifier 25 (significant service) for routine vaccines.
- Fix: Reserve 25 for separately identifiable E/M services.
- Ignoring Telehealth Rules:
- Example: Coding 99213 for asynchronous telehealth (use 99421 instead).
- Overlooking Chronic Care Documentation:
- Example: Failing to document time spent on care coordination for 99491.
- Missing Preventive Service Bundles:
- Example: Billing 99396 alone when obesity counseling is included.
Case Studies - Real-World Coding Scenarios
Case 1: Diabetes Management
- Patient: 58-year-old with hysterical diabetes (A1C 9.2%).
- Services: 30-minute visit + Rx adjustment + glucose monitor training.
- Codes: 99214 (E/M) + 99491 (chronic care) + 95250 (CGM training).
Case 2: Medicare Annual Wellness Visit
- Patient: 72-year-old with hypertension and mild cognitive decline.
- Services: AWV + depression screening + care plan.
- Codes: G0439 (AWV) + G2211 (behavioral health) + 99483 (cognitive assessment).
Conclusion
Mastering Primary Care Codes is vital for providers to ensure accurate reimbursement and compliance with payer guidelines. From preventive visits (99396) to chronic care management (99491) and telehealth codes (99421), primary care billing in 2025 requires attention to detail and proper documentation.
At ExpressMBS, we provide tailored primary care billing and coding solutions to optimize your revenue cycle. Our experts help you avoid denials, apply modifiers correctly, and maximize reimbursement, so you can focus on what matters most: caring for patients.
Contact us today at (813) 308-9121 or email info@expressmbs.com for expert support.
Frequently Asked Questions (FAQs)
Primary Care Codes are CPT and HCPCS codes used for billing office visits, preventive care, telehealth, chronic care management, and other routine services provided by family practice, internal medicine, and general practitioners.
The most common CPT codes for primary care visits are:
- 99213 – Established patient, low complexity.
- 99214 – Established patient, moderate complexity.
- 99202 – New patient, low complexity.
These are the backbone of primary care billing.
The most common CPT codes for primary care include:
- 99213, 99214 (office visits)
- 99396 (preventive visit, ages 40–64)
- 90471 (vaccine administration)
- 99491 (chronic care management)
- G2211 (behavioral health integration)
Yes, a primary care CPT code cheat sheet includes codes for office visits, preventive care, vaccines, chronic care, and telehealth. Many practices create quick-reference PDFs for their billing staff.
Internal medicine CPT codes overlap with primary care and include:
- 99213 & 99214 (follow-ups for chronic conditions).
- 99202 & 99204 (new patient visits).
- 99491 (chronic disease management).
The main preventive visit CPT codes are 99381–99397. They are age-specific:
- 99381–99385 for pediatric/adolescent patients.
- 99386–99397 for adults.
These codes also cover screenings like cancer, obesity counseling, and wellness checks.
A sick visit CPT code usually falls under 99213 or 99214, depending on the complexity and time spent during the encounter.
For 2025, new or updated primary care billing codes include:
- 99491 (new chronic care management, replacing 99487).
- 99421–99423 (expanded asynchronous telehealth).
- G2211 (behavioral health integration during routine visits).
Both specialties use similar primary care CPT codes (99213, 99214, 99396, etc.).
But internal medicine may bill more frequently for chronic disease management (99491), while family practice codes often include pediatric and preventive visits (99381–99397).
