If you practice family medicine or internal medicine, your entire revenue picture runs through a surprisingly short list of codes. CMS publishes an annual report of the top 200 CPT codes by service volume across all of Medicare, and the pattern is consistent year over year: office E/M codes dominate medicine, with 99214 the single most-billed code in healthcare by total charges. The list below is the primary care subset that matters, organized by how you use them.
Providers who know this list cold, and know the one documentation hook each code requires, capture more of their earned work than providers who know twice as much theory. This is the practical core.
The Daily Drivers: Office E/M
These are the office visit codes you will use most; the full wRVU values for each appear in the reference table in the chapter on how you get paid, so they are not repeated in full here. What matters on this page is recognizing which code each visit actually supports.
| Code | Service | wRVUs | The one thing your note needs |
|---|---|---|---|
| 99214 | Established, moderate | 1.92 | Two chronic conditions addressed, or one worsening, or Rx management documented |
| 99213 | Established, low | 1.30 | One stable chronic or acute uncomplicated problem, actively addressed |
| 99215 | Established, high | 2.80 | Severe exacerbation, or drug therapy with intensive monitoring, or 40+ documented minutes |
| 99204 | New patient, moderate | 2.60 | Same moderate MDM as 99214, plus the patient is new (3-year rule) |
| 99203 | New patient, low | 1.60 | Low MDM; do not default here when 99204 criteria are met |
| 99205 | New patient, high | 3.50 | High MDM or 60+ documented minutes |
| 99212 | Established, straightforward | 0.70 | Minimal problem; rarely the right code for a physician visit |
National Medicare data bears this out: 99214 is the single most frequently billed office visit code, and level 4 visits (99214) now outnumber level 3 visits (99213) nationally, a reversal from a decade ago as clinicians have coded more accurately under the 2021 rules. If your own distribution still leans heavily toward 99213, that is the first place to look for undercoding (see the undercoding chapter).
The Add-Ons Most Practices Miss
| Code | Service | wRVUs | The one thing your note needs |
|---|---|---|---|
| G2211 | Longitudinal care add-on | 0.33 | You are the ongoing focal point of care; no procedure with Mod 25 same day (AWV excepted) |
| 99406 | Tobacco cessation, 3–10 min | 0.24 | Counseling time documented, 3-minute minimum |
| 99407 | Tobacco cessation, >10 min | 0.50 | Counseling time documented, over 10 minutes |
| G0447 | Obesity counseling | 0.45 | 15 minutes face-to-face, BMI documented |
| 99497 | Advance care planning | 1.50 | Voluntary discussion of directives, first 30 minutes, time documented |
| G2212 | Prolonged services (Medicare) | 0.61 | Time-based 99215/99205 plus a full 15 minutes beyond the max (see Chapter 11 ) |
Wellness and Prevention
| Code | Service | wRVUs | The one thing your note needs |
|---|---|---|---|
| G0438 | Initial Medicare AWV | 2.43 | All required AWV components; once per beneficiary lifetime |
| G0439 | Subsequent Medicare AWV | 1.50 | Updated prevention plan; every year after the first |
| 99395–97 | Established preventive exam (adult) | 1.75–2.00 | Age-appropriate comprehensive preventive evaluation |
| G0444 | Depression screening | 0.18 | Validated instrument, annual, in primary care setting |
| G0442 | Alcohol misuse screening | 0.18 | Annual validated screening documented |
The AWV plus a problem-oriented E/M with Modifier 25 plus G2211 is the single best-reimbursed routine visit pattern in Medicare primary care. The step-by-step is in Chapter 16.
Between-Visit Care: The Codes for Work You're Already Doing
| Code | Service | wRVUs | The one thing your note needs |
|---|---|---|---|
| 99495 | Transitional care, moderate | 2.78 | Contact within 2 business days of discharge, visit within 14 days |
| 99496 | Transitional care, high | 3.79 | Contact within 2 business days, visit within 7 days, high-complexity MDM |
| 99490 | Chronic care mgmt, clinical staff | 0.61 | 2+ chronic conditions, 20 min/month of documented non-face-to-face care, patient consent |
| 99491 | CCM by physician/QHP | 0.85 | 30 min/month of personally performed care management |
Transitional care management deserves special attention: a 99496 is worth nearly two 99214s, and the post-discharge work it describes is work most practices already do informally. To actually earn it, document three things: an interactive contact (phone or in person) with the patient or caregiver within two business days of discharge; a face-to-face visit within 7 days (for high complexity, 99496) or 14 days (moderate, 99495); and medication reconciliation by the date of that visit. Record the discharge date, the date and type of the two-day contact, the date of the face-to-face visit, and the medication reconciliation, and the code is supported. It remains one of the most underbilled high-value codes in primary care precisely because the work happens but the dates do not get documented.
Common In-Office Procedures
| Code | Service | wRVUs | The one thing your note needs |
|---|---|---|---|
| 69210 | Cerumen removal, impacted | 0.61 | Instrumentation required (not just lavage by staff); unilateral |
| 17110 | Destruction of benign lesions | 0.70 | Method and number of lesions (up to 14) |
| 11102 | Skin biopsy, tangential | 0.66 | Lesion site and technique; pathology sent |
| 12001 | Simple laceration repair, ≤2.5 cm | 0.84 | Length, location, and closure method documented |
| 10060 | I&D of abscess, simple | 1.22 | Incision and drainage technique documented |
How to Use This List
Use this list as a working checklist. Pull your last quarter's billing report and compare it against these codes one by one. The question for each: did the clinical work for this code happen in my practice last quarter, and did the code get billed? For most primary care practices, the gaps cluster in the same five places: G2211, TCM, advance care planning, tobacco cessation, and the Modifier 25 procedure-plus-E/M combination. Close those five and you have captured most of what a full coding overhaul would find. (The always-current version of this list, and a one-page reference you can keep at your desk, live on the website at physiciancodingguide.com.)
Track your own numbers with the free wRVU Tracker at physiciancodingguide.com, which includes every code on this page.
The Level-4 Hook in Practice
The single highest-value habit in primary care coding is recognizing the legitimate level 4. Consider a routine follow-up: a patient with hypertension and hypothyroidism comes in stable, you review home blood pressure logs, continue the lisinopril, and adjust the levothyroxine after looking at a recent TSH. It is tempting to code this a level 3 out of habit. But you addressed two chronic conditions, reviewed data, and managed prescription medications, which is moderate complexity on more than one axis. This is a 99214, and coding it a 99213 by reflex is the most common way primary care leaves money behind, visit after visit.