A 58-year-old comes in for an annual physical and mentions chest tightness on the stairs. The internist works it up, orders an ECG and labs, and adjusts her blood pressure medication. That one visit is a preventive service, a problem-oriented visit, a diagnostic test, and possibly a care management relationship, and each part has its own billing rule and its own cost-sharing for the patient.
Key Takeaways
- A preventive visit and a significant problem addressed at the same visit are billed separately, with modifier 25 on the problem-oriented E/M.
- Office E/M levels are chosen by medical decision-making or total time on the date, including time spent before and after the visit.
- G2211 adds payment for the ongoing relationship with a patient’s single serious or complex condition, and since 2025 it can be billed with a modifier 25 visit on the same day as a preventive service.
- Incident-to billing under the physician’s NPI only applies to established patients with an existing plan of care and direct supervision in the office.
- Chronic care management, transitional care management, and remote monitoring pay for work between visits that many practices already do.
Preventive and Problem Visits on the Same Day
For commercial plans, a preventive visit bills under the age-based preventive codes (99385 to 99387 for new patients, 99395 to 99397 for established patients). For Medicare, it bills as the annual wellness visit (G0438 or G0439), since Medicare doesn’t cover the routine physical. When the internist also evaluates and manages a significant problem, such as new symptoms or a medication change for an uncontrolled condition, that work bills as an office E/M visit with modifier 25.
The problem-oriented portion has to stand on its own in the note, and its level reflects only that work, not the preventive history and exam. The patient usually owes their copay or coinsurance on the problem visit even when the preventive visit is free, so front desk staff should explain that before checkout. Our guide to using modifier 25 correctly covers the documentation that holds up on review.
Office E/M Levels and G2211
Office visits bill as 99202 to 99205 for new patients and 99212 to 99215 for established patients. The level is chosen by medical decision-making or by total time the physician spends on the patient that day, including reviewing records, documenting, and coordinating care. A visit managing several chronic conditions with medication changes often supports 99214, and one involving a drug that needs close monitoring for toxicity can support 99215.
Medicare pays G2211 as an add-on to office E/M visits when the practitioner is the ongoing focal point for the patient’s care or manages a single serious or complex condition over time. That describes most internal medicine relationships. Since 2025, G2211 can also be billed when the E/M carries modifier 25 because it was done on the same day as an annual wellness visit, a vaccine administration, or another Part B preventive service. Office visits that run well past the time for 99205 or 99215 can add G2212 for Medicare or 99417 for many commercial plans.
In-Office Testing
Many internal medicine practices run tests in the office. A 12-lead ECG with interpretation bills as 93000, spirometry as 94010, and venipuncture as 36415. Point-of-care lab tests such as hemoglobin A1c, urinalysis, or rapid strep are usually CLIA-waived. Medicare requires the QW modifier on those tests, and the practice needs an active CLIA certificate of waiver covering them.
Tests ordered and interpreted by the same internist who saw the patient are billed in addition to the E/M visit. Tests sent to an outside lab are billed by the lab, and only the specimen collection is billed by the practice.
Care Between Visits
Internists manage patients with several chronic conditions, which is the population Medicare’s care management codes were built for. Chronic care management (99490 and 99439 for clinical staff time, 99491 for physician time) covers patients with two or more chronic conditions and requires documented consent. Principal care management covers one complex condition. Advanced Primary Care Management (G0556 to G0558) pays a monthly amount by complexity tier and replaces CCM and PCM for the same patient in the same month.
Transitional care management (99495 and 99496) covers the 30 days after a hospital or facility discharge, with interactive contact within two business days and a face-to-face visit within 7 or 14 days depending on complexity. Remote physiologic monitoring for patients with hypertension or diabetes bills under its own codes, covered on our remote patient monitoring page. Our geriatric medicine page goes deeper on care management rules for older patients.
NPs, PAs, and Incident-To
Nurse practitioners and physician assistants bill under their own NPI by default, and Medicare pays those visits at 85% of the physician fee schedule. A visit can be billed incident-to under the physician’s NPI at 100% only when the patient is established, the NPP is following a plan of care the physician started, and a physician from the group is physically in the office suite during the visit.
A new patient, or a new problem for an established patient, doesn’t qualify for incident-to and has to be billed under the NPP’s own number. Many commercial plans don’t recognize incident-to at all. Billing NPP visits under the physician without meeting those conditions is a common audit finding in internal medicine.
Quality Reporting
Internists billing Medicare Part B report through the Merit-based Incentive Payment System unless they’re in a qualifying alternative payment model. Measures common in internal medicine include blood pressure control, diabetes control, and preventive screenings. Practices that capture these measures from the record as they go, instead of at year end, report more accurately and avoid payment adjustments two years later.
Internal Medicine Credentialing
Board certification and enrollment
Internists certify through the American Board of Internal Medicine, and many add subspecialty or focused practice certifications. Payers verify board status, licensure, DEA registration, and malpractice history, usually through CAQH ProView. Medicare enrollment runs through PECOS, with reassignment to the group.
Primary care designation
Many commercial and Medicare Advantage plans list internists as primary care physicians who can be chosen as a member’s PCP and receive attributed patients. That designation depends on how the internist is credentialed with each plan. An internist enrolled only as a specialist may not appear in the PCP directory, which limits new patients and can affect value-based contract attribution.
NPs and PAs
Each NP and PA needs their own enrollment with every plan the practice bills. Until each one is approved, their visits can’t be billed under their own number, which is why you can’t bill what you can’t credential. Practices with a mix of internists and family physicians can also see our primary care page.
Internal Medicine Billing FAQs
Can a preventive visit and a sick visit be billed on the same day?
Yes, when a significant problem is evaluated and managed beyond the preventive service. The problem-oriented visit bills as an office E/M with modifier 25, and the patient’s usual cost-sharing applies to it.
When can G2211 be billed?
With office E/M visits when the practitioner is the patient’s ongoing focal point for care or manages a serious or complex condition over time. Since 2025, it can also be billed with a modifier 25 visit on the same day as an annual wellness visit, vaccine administration, or Part B preventive service.
How is the level of an office visit chosen?
By medical decision-making or by total time the practitioner spends on the patient that day, including time before and after the face-to-face visit.
Can NP visits be billed under the physician’s NPI?
Only incident-to, when the patient is established, the NP is following the physician’s plan of care, and a physician is physically in the office suite. Otherwise, the visit bills under the NP’s NPI at 85% for Medicare.
Does Medicare cover an annual physical?
No. Medicare covers the annual wellness visit (G0438 or G0439), which focuses on prevention planning rather than a full physical exam.
Do in-office lab tests need a modifier?
CLIA-waived tests billed to Medicare need the QW modifier, and the practice needs an active CLIA certificate of waiver.
Why Internists Choose Medwave for Billing & Credentialing
Medwave handles internal medicine billing, credentialing, and payer contracting under one team. We split preventive and problem visits correctly, add G2211 where it applies, check incident-to conditions before billing NPP visits under the physician, and capture care management and in-office testing. That’s how we hold a 98% clean claim rate.
On credentialing, we enroll internists, NPs, and PAs with Medicare, Medicaid, and commercial plans, including PCP designation where plans offer it, with a 60-day average turnaround.
Contact Medwave below to see how we can support your internal medicine practice.