Visit level consistency
Review leveling patterns across providers so the practice is neither under-billing nor exposed on audit.
Primary care | Texas
Primary care billing where volume makes small errors expensive.
Primary care lives on thin margins and high claim counts. A modifier applied inconsistently or a wellness visit billed as a problem visit repeats hundreds of times a month. T Zync fixes the pattern, not the individual claim.
Designed for
Independent primary care and internal medicine practices in Texas
No PHI through public forms
01 Why primary care is different
One repeated error becomes hundreds of claims.
Primary care errors scale. A practice that habitually bills a preventive visit and a problem visit together without supporting the separate service will see the same denial on every affected encounter, and a practice that under-levels its established patient visits loses a small amount on nearly every claim it files.
The opportunity is equally repeatable. Chronic care management, transitional care after discharge, annual wellness visits and remote monitoring are payable services that many independent practices either never start billing or start and then abandon because the time documentation is unclear.
T Zync works the pattern: consistent leveling, disciplined modifier use, and the care-management revenue most primary care practices are entitled to and never collect.
02 What we handle
The full primary care revenue cycle.
Modifier 25 discipline
Apply the separate-service modifier only where documentation supports it, and defend it when it is challenged.
Preventive and problem visits
Bill a wellness visit and a problem-focused service on the same day correctly when both are performed.
Annual wellness visits
Bill Medicare's initial and subsequent wellness visits with the required elements documented.
Chronic care management
Bill monthly care management on documented time with a recorded care plan.
Transitional care management
Capture post-discharge management within the required contact and visit windows.
Remote monitoring
Bill device supply and management time where the monitoring program meets requirements.
Immunization and in-office services
Bill vaccine product and administration correctly, including counselling-based administration codes.
03 Codes that carry primary care revenue
The code families this work lives in.
Primary care revenue is spread across many small services, which makes consistency matter more than any single code.
| Code family | What it covers |
|---|---|
| 99202–99215 | Office and outpatient evaluation and management for new and established patients, selected on medical decision making or total time. |
| G2211 | The visit complexity add-on recognising ongoing responsibility for a patient's longitudinal care. |
| 99381–99397 | Preventive medicine visits for new and established patients across age bands. |
| G0438, G0439 | Medicare initial and subsequent annual wellness visits, each with their own required elements. |
| 99490, 99439 | Chronic care management, first increment and each additional increment of documented clinical staff time per month. |
| 99495, 99496 | Transitional care management after discharge, governed by contact timing and the face-to-face visit window. |
| 99453, 99454, 99457, 99458 | Remote physiologic monitoring setup, device supply, and management time. |
| Modifier 25 | Identifies a significant, separately identifiable evaluation and management service performed on the same day as another service. |
| Preventive plus problem visits | Requires documentation that separates the preventive service from the problem-focused work billed alongside it. |
Codes listed reflect common documentation scenarios in this specialty and are shown for orientation. Correct code selection always depends on the documentation, the payer's policy and the current code set for the year of service. T Zync verifies current payer policy at the time of billing.
04 How it runs
Pattern-level correction at primary care volume.
- 01
Baseline
Measure leveling distribution, modifier use and care-management capture across providers.
- 02
Correct
Fix the repeated patterns first, since they carry the most money at this volume.
- 03
Capture
Start or restart the payable care-management services the practice is not billing.
- 04
Hold
Monitor the same measures monthly so the correction does not decay.
05 Texas payer landscape
The payers and deadlines that decide a Texas claim.
At primary care volume, a filing backlog of a few weeks puts hundreds of claims at risk at once. These are the rules that decide whether a balance is still recoverable.
| Payer or rule | What it means for your claims |
|---|---|
| Medicare – Novitas Solutions (Jurisdiction H) | The Part B contractor for Texas. Claims carry a twelve-month timely filing limit from the date of service, and a redetermination must be requested within 120 days of the initial determination notice. |
| Texas Medicaid (TMHP) | Fee-for-service claims must be filed within 95 days of the date of service, one of the shortest limits in the country and a frequent cause of unrecoverable Texas denials. |
| Medicaid managed care (STAR, STAR+PLUS) | Each managed care plan applies its own filing, authorization and appeal rules on top of state policy, so payer-specific edits matter more than a single Medicaid workflow. |
| Texas prompt pay | State-regulated HMO and PPO plans carry statutory deadlines for paying clean claims, which gives a documented clean submission real leverage in follow-up. |
| Commercial and Medicare Advantage | Filing limits are contract-specific and commonly range from 90 to 180 days, so the follow-up calendar should be driven by the contract rather than by habit. |
| Volume and filing risk | A single workflow interruption at primary care claim volume can push several hundred claims toward the same filing deadline, which makes submission lag a bigger risk here than in low-volume specialties. |
Filing limits and appeal windows are set by payer policy and by contract, and they change. T Zync verifies the applicable deadline per payer at the time of work.
FAQ Primary care billing guidance
Primary care billing questions, answered clearly.
For guidance specific to your specialty, payer mix and systems, speak with T Zync.
When can modifier 25 be used?
When a significant, separately identifiable evaluation and management service is performed on the same day as another procedure or service, and the documentation shows work beyond the usual pre- and post-service care of that procedure. Applying it routinely is a well-known audit trigger.
Can a wellness visit and a problem visit be billed on the same day?
Yes, when both are performed and the documentation separates them. The preventive service is billed with the problem-focused visit appended under the appropriate modifier, and the note must make the separate work visible.
What is G2211 for?
It is an add-on recognising the additional complexity of serving as the continuing focal point for a patient's care, which fits the primary care relationship directly. Practices that never bill it are leaving supported revenue uncollected.
Why do practices stop billing chronic care management?
Usually because the time tracking and care-plan documentation are not built into the workflow, so the claims become difficult to support. Once the capture is systematised, the revenue is predictable and recurring.
What is the timely filing limit for Texas Medicaid?
Texas Medicaid fee-for-service claims must be filed within 95 days of the date of service. At primary care volume, a filing backlog of even a few weeks can put a significant number of claims at risk.
Do you review leveling across providers?
Yes. Distribution is compared across providers in the practice, which usually surfaces both under-billing and inconsistency faster than reviewing individual claims.
06 Keep exploring
Related services and specialties.
Independent review
Medical Audits
Coding and documentation review with financial impact in both directions.
Front-desk capacity
Virtual Assistance
Scheduling, eligibility and patient calls handled by trained assistants.
Nearby specialty
Behavioral Health Billing in Texas
Psychotherapy time codes, telehealth rules and collaborative care.
Start with clarity