Outpatient billing, explained without the jargon
How-to guides on the codes, modifiers, and timing rules that most often trip up practicing clinicians. Each guide is written for the workflow you actually do, with examples, documentation templates, and direct links to the related code pages.
Articles
How to Bill G2211 with Modifier 25 (or, Why You Probably Cannot)
G2211 cannot be billed with modifier 25 in most situations. Here is the rule, the exceptions, and how to decide which to use on a same-day encounter.
99214 Time vs MDM in 2026: Which Method Should You Pick?
The 2021 E/M guidelines let you bill 99214 by time or MDM. Here is the decision tree, with documentation templates for each method.
Subsequent AWV (G0439) Frequency Rules: Avoiding the 12-Month Trap
Medicare denies G0439 if billed within 365 days of the prior AWV. Here is how the frequency rule works and how to time AWVs across your panel.
How to Bill Modifier 25 Correctly (and When You Cannot)
Modifier 25 carves an E/M out of a same-day procedure or preventive service. Here is when to use it, when to skip it, and the documentation that survives audit.
Telehealth Billing in 2026: POS 02, POS 10, POS 11 and Modifier 95
Telehealth billing requires the right place-of-service code plus modifier 95. Here is how POS 02, POS 10, and POS 11 differ and which payer wants which in 2026.
CCM (99490) vs TCM (99495 / 99496) in the Same Month: How to Choose
A patient discharged from the hospital can trigger both chronic care management and transitional care management. Medicare lets you bill only one per calendar month. Here is the decision tree.
99232 vs 99233: Time vs MDM for Hospitalist Subsequent Visits
Hospitalist subsequent visits split between 99232 (moderate) and 99233 (high). Here are the time thresholds, MDM elements, and the decision tree.
When to Use G2211 (With Real Examples)
G2211 attaches to an office E/M when you are the continuing focal point of a patient's care. Here is who qualifies, with concrete examples and the cost-share caveat.
AWV vs IPPE vs Subsequent AWV: G0402, G0438, G0439
IPPE (G0402), initial AWV (G0438), and subsequent AWV (G0439) are three different Medicare preventive visits. Here is the decision tree and the timing rules.
TCM 99495 vs 99496: Documentation and the Timing Rules
Transitional Care Management hinges on a 2-business-day contact and a 7 or 14 day face-to-face. Here is how 99495 and 99496 differ and what documentation each needs.
Each guide links to the relevant code pages. Or jump straight to the full library.
Educational reference, not billing or legal advice. Verify against payer contracts and your compliance team before claim submission.