Geriatric medicine practices manage the most medically complex and highest-utilizing patients in Medicare—yet chronic care management, transitional care, and advance care planning codes remain among the most underused in the specialty. VeriMedix delivers the RCM expertise to capture every billable service your geriatricians provide.
Geriatric medicine billing is almost exclusively a Medicare and Medicare Advantage billing landscape. The code set extends well beyond standard E/M codes to include Chronic Care Management (CCM: 99490, 99491, 99439, 99437), Complex CCM (99487, 99489), Transitional Care Management (99495, 99496), Annual Wellness Visits (G0402, G0438, G0439), Advance Care Planning (99497, 99498), and nursing facility care codes (99304–99310, 99315–99316). Each of these services reflects care that geriatricians routinely deliver but frequently fail to bill for due to inadequate workflows or staff training gaps.
Nursing and long-term care facility billing introduces a distinct set of codes and rules. Initial nursing facility care is billed with 99304–99306, subsequent care with 99307–99310, and discharge with 99315–99316. The frequency of visits varies by payer and medical necessity documentation requirements. For patients in the home or residence setting, codes 99341–99345 (new patient) and 99347–99350 (established patient) apply. CMS also recognizes Principal Care Management (PCM, 99424–99427) for patients with a single high-risk or complex chronic condition, which overlaps with but is distinct from CCM. Understanding the eligibility and billing rules for each program is essential to avoid duplicate billing denials.
Geriatric medicine also encompasses specialized assessment services that carry direct reimbursement. Comprehensive geriatric assessment, while not a distinct CPT code, is captured through high-level E/M codes with comprehensive MDM documentation. Cognitive impairment assessment billed during an AWV or separately using codes such as 99483 (Assessment of and care planning for a patient with cognitive impairment) is a growing revenue opportunity as dementia prevalence rises. SDOH screening (G0136), depression screening (G0444), and advance care planning add-ons further enhance AWV visit value. Geriatric practices that bill each of these services accurately and consistently significantly outperform those that bill only standard E/M codes.
Below are commonly billed codes our certified coders manage for geriatric medicine practices. Always confirm payer-specific coverage and current code values.
| Code | Description | Billing note |
|---|---|---|
99215 | Office/outpatient visit, established patient, high complexity (40–54 min or high MDM) | Standard for complex multi-morbidity geriatric visits; document high MDM with multiple chronic conditions |
G0439 | Medicare Annual Wellness Visit, subsequent | Core annual preventive code for Medicare patients; includes cognitive impairment screening, depression review, prevention plan |
99490 | Chronic Care Management (CCM), first 20 minutes clinical staff time per calendar month | Essential for geriatric patients with 2+ chronic conditions; requires care plan, consent, 24/7 access |
99495 | Transitional Care Management, moderate MDM; face-to-face visit within 14 days of discharge | Captures post-hospital coordination; interactive contact within 2 business days of discharge required |
99496 | Transitional Care Management, high MDM; face-to-face visit within 7 days of discharge | Higher reimbursement for highest-complexity post-discharge patients; requires high MDM and timely visit |
99483 | Assessment of and care planning for patient with cognitive impairment | Includes structured assessment of cognition, functional status, neuropsychiatric symptoms, caregiver evaluation, and care plan; typically 50 minutes |
99497 | Advance Care Planning, first 30 minutes (minimum 16 minutes required) | Billable separately or as AWV add-on; covered 100% with no patient cost-sharing when billed with AWV |
99306 | Initial nursing facility care, high complexity | Used for initial evaluation in skilled nursing or long-term care; document high MDM or ≥50 minutes |
99309 | Subsequent nursing facility care, moderate complexity | Common for regular nursing facility visits; medical necessity and clinical condition must be documented |
Our standard operating procedures for geriatric medicine revenue cycle management — the step-by-step workflow we follow on every claim:
These are the issues we see most often in geriatric medicine billing — and exactly how we resolve them:
Practices assume CCM cannot be billed for nursing facility residents, missing significant monthly revenue. Fix: CCM (99490) can be billed for nursing facility patients if all eligibility requirements are met and the billing provider is not also billing a monthly global nursing facility code for the same patient during the same period. Confirm payer rules and document non-face-to-face care activities separately.
Practices track acute hospital discharges for TCM but miss SNF discharges, where TCM is equally applicable. Fix: Expand discharge tracking workflows to capture all qualifying discharge settings (acute hospital, SNF, inpatient rehab); assign a dedicated staff member to monitor discharge lists from all facilities where the practice has patients.
Geriatric practices rarely bill 99483 despite performing structured cognitive assessments. Fix: Add 99483 to the charge capture workflow as a billable service for any encounter that includes a structured cognitive assessment using a validated tool (e.g., MoCA, MMSE), caregiver interview, and care plan documentation.
ACP discussions are performed during AWV encounters but not billed as a separate add-on (99497/99498), leaving reimbursement on the table. Fix: Document ACP start/stop time, the nature of the discussion, and who was present; bill 99497 in addition to the AWV code.
Providers habitually bill 99307 (low complexity) for patients whose clinical complexity supports 99308 or 99309. Fix: Train providers on nursing facility E/M level selection using MDM criteria; review a sample of claims quarterly to identify systematic undercoding.
Verimedix works inside the systems geriatric medicine practices already use, including:
Yes, subject to specific restrictions. CCM and TCM may be billed concurrently in the same month when time and effort are tracked separately. An AWV (G0438/G0439) may be billed the same day as an E/M visit with modifier -25. CCM cannot be billed during the same 30-day period that overlaps with a TCM service period unless time is tracked separately.
There is no single CPT code called 'comprehensive geriatric assessment.' The service is captured through high-level E/M codes (99215) supported by high-MDM documentation. CPT 99483 specifically covers assessment and care planning for cognitive impairment. CCM and care coordination codes cover the ongoing management aspect.
Nursing facility initial care codes (99304–99306) and subsequent care codes (99307–99310) are specific to the skilled nursing facility setting (POS 31). They have different time and MDM thresholds than office visit codes. Discharge codes (99315–99316) are time-based. These codes cannot be substituted with office E/M codes.
Yes. Medicare covers CPT 99483 (cognitive impairment assessment and care planning) as a separate billable service. The visit typically takes 50 minutes or more and requires a structured assessment, caregiver evaluation, and a written care plan. It can be billed once per year per patient.
Document the date and start/stop time or total face-to-face time, the nature of the ACP discussion, what advance care directive options were reviewed, who was present (patient, family members, surrogate), and whether a directive was completed. The minimum documented time to bill 99497 is 16 minutes. If performed on the same day as an AWV, the note should show these as distinct services.
Common geriatric ICD-10 codes include Z00.01 (health exam with abnormal findings), F03.90 (unspecified dementia without behavioral disturbance), G30.9 (Alzheimer's disease, unspecified), M81.0 (age-related osteoporosis), Z87.39 (personal history of osteoporosis), and R41.3 (other amnesia). For AWVs, Z00.00 (general adult medical examination without abnormal findings) is standard. ICD-10 code specificity directly affects medical necessity determinations.
Verimedix handles the entire geriatric medicine revenue cycle — coding, submission, denials, and A/R — so your team can focus on patients.