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Clinical Specialty Hub CY 2026 / FY 2027 Guidelines
Verified: 2026-09-29

Primary Care & Family Medicine Coding Hub

Comprehensive outpatient evaluation and management (E/M) coding, preventive medicine wellness checkups, chronic disease management, and transitional care.

Top Diagnoses: 7 Core Codes
Top Procedures: 7 Core Procedures
Auditing Focus: High Priority
Data Source: CMS & Clinical Society Guidelines
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Core Specialty Coding Directive

What are the critical billing rules for Primary Care & Family Medicine Coding Hub? CMS add-on code G2211 may be billed with established outpatient office visits (99213-99215) when the provider serves as the continuing focal point for all needed medical care.

Updated for current Medicare Part B coverage policies and NCCI quarterly edit tables.

Frequently Billed ICD-10-CM Diagnosis Codes

Click any diagnosis code to view complete CDC tabular guidelines, Excludes 1 exclusions, and billability status:

I10 →
Essential (primary) hypertension
E11.9 →
Type 2 diabetes mellitus without complications
Z00.00 →
Encntr for general adult medical exam w/o abnormal findings
Z23 →
Encounter for immunization
R05.9 →
Cough, unspecified
J06.9 →
Acute upper respiratory infection, unspecified
E78.5 →
Hyperlipidemia, unspecified

Common CPT & HCPCS Procedure Codes

Code Description Reimbursement Bridge
99213 Office or other outpatient visit, established patient, low level MDM, 20-29 minutes View RVU ($94.29) →
99214 Office or other outpatient visit, established patient, moderate level MDM, 30-39 minutes View RVU ($131.61) →
99215 Office or other outpatient visit, established patient, high level MDM, 40-54 minutes View RVU ($188.58) →
99395 Specialty procedure or diagnostic service Standard PFS Code
99396 Specialty procedure or diagnostic service Standard PFS Code
G2211 Visit complexity add-on code inherent to ongoing evaluation and management services View RVU ($16.04) →
99490 Specialty procedure or diagnostic service Standard PFS Code

Essential Billing Modifiers for Primary Care & Family Medicine Coding Hub

Modifier 25 Guidelines → Modifier 33 Guidelines → Modifier 59 Guidelines →
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High-Risk Documentation & Audit Traps

CMS add-on code G2211 may be billed with established outpatient office visits (99213-99215) when the provider serves as the continuing focal point for all needed medical care.
Audit Defense Recommendation: Medical records must contain explicit physician-authored clinical notes demonstrating medical necessity. Review NCCI PTP edits prior to submission using our free NCCI Edit Checker.
AAPC CPC Exam Focus

Certification Exam Key Concepts

The cornerstone of the CPC exam: medical decision making (MDM) table leveling, total encounter time thresholds, and preventive vs problem-oriented visit split billing.

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