Complete Guide to Primary Care CPT Codes (2025)

Primary Care CPT Codes are standardized billing codes used by physicians and healthcare providers to describe the medical services they provide during a patient visit. CPT codes help primary care providers document services properly and receive timely, accurate payments from insurance companies. Common examples include codes for office visits, preventive care, and chronic disease management.

CPT codes are crucial in primary care billing because they directly impact how a provider gets reimbursed. Incorrect or missing codes can lead to claim denials, delayed payments, or audits. They also help in maintaining accurate patient records, tracking treatment history, and ensuring compliance with payer requirements.

The most frequently used CPT codes for routine primary care visits are:

• 99213 – Established patient, low complexity
• 99214 – Established patient, moderate complexity
• 99203 – New patient, low complexity
  These codes cover evaluation and management (E/M) services, and the level depends on time spent and medical decision-making involved.

Choosing the right CPT code depends on:

• Patient status (new or established)
• Complexity of medical decision-making
• Time spent on face-to-face care
• Services provided (preventive, diagnostic, chronic care, etc.)
  It’s best to follow CMS guidelines and use an EHR system that assists with code selection based on documentation.

• 99213 is used for visits involving low-complexity problems requiring 20–29 minutes with the patient.
• 99214 is used for moderate-complexity problems requiring 30–39 minutes.
  The variance lies in the depth of medical decision-making and time consumed. Accurate documentation is vital to support the level billed.

For Medicare patients, the CPT codes used for Yearly Wellness Visits are:

• G0438 – Initial Annual Wellness Visit
• G0439 – Subsequent Annual Wellness Visit
  These codes differ from standard preventive visits and include personalized prevention planning.

You can bill several CPT codes in one visit when separate services are delivered and clearly supported by documentation. For example, you can bill an E/M code (like 99214) along with a minor procedure or diagnostic test. Using the modifier -25 to indicate a significant, separately identifiable service.

• 99490 – 20+ minutes of non-face-to-face CCM services per month

• 99491 – 30+ minutes of physician time
  these codes are used when managing two or more chronic conditions and must meet care coordination criteria. They offer additional reimbursement opportunities for primary care providers.

Yes, especially post-COVID, telehealth is widely covered. Common CPT Codes include:

• 99212–99215 for video-based visits (with modifier -95 or -GT)
  Always verify payer-specific guidelines and documentation requirements.
• 99441–99443 for audio-only visits