Geriatrics — Medicare Wellness & CCM Revenue, Captured
Geriatric practices miss revenue on wellness visits, CCM, TCM, and cognitive assessments. Our specialists maximize Medicare geriatric care management codes and chronic care coordination billing.
Proven Results
- 22.5% Average Revenue Increase
- 98.5% First-Pass Claim Rate
- 36.2% Reduction in Denials
- 12.8 Days Faster Payment Collection
Common Billing Challenges
Surgical Global Period Management
Geriatric surgeries have 90-day global periods where most related services are bundled, requiring careful tracking to avoid denials.
Fracture Care Billing Complexity
Fracture treatment includes initial care, follow-ups, and cast changes within the global package, with specific rules for when to bill separately.
Implant & Hardware Cost Recovery
High-cost implants, plates, screws, and prosthetics require separate billing with proper documentation and manufacturer information.
Arthroscopy Procedure Bundling
Multiple arthroscopic procedures on the same joint require proper modifier usage to prevent bundling and ensure full reimbursement.
Workers Compensation Claims
Work-related geriatric injuries involve different coding requirements, fee schedules, and authorization processes than standard insurance.
Imaging Coordination & Billing
Geriatric practices often provide in-office imaging requiring technical and professional component billing with proper modifiers.
Our Solutions
Geriatric Surgery Billing Specialists
Our team includes certified coders with specialized training in geriatric procedures, global period management, and implant billing.
- Expert CPT coding for all geriatric procedures
- Global period tracking and management
- Proper modifier application for multiple procedures
- Maximized reimbursement for complex surgeries
Implant Cost Recovery Expertise
Dedicated support for tracking and billing high-cost implants, hardware, and prosthetics with proper documentation.
- Accurate implant billing with manufacturer codes
- HCPCS code expertise for geriatric supplies
- Documentation support for medical necessity
- Full cost recovery for expensive hardware
Global Period Tracking Systems
Advanced technology automatically tracks global periods and identifies billable services that fall outside global packages.
- Automated global period monitoring
- Alerts for separately billable services
- Modifier 24 and 25 guidance
- Reduced denials from global period errors
Workers Compensation Expertise
Specialized knowledge of workers comp billing requirements, fee schedules, and authorization processes for geriatric injuries.
- State-specific workers comp compliance
- Fee schedule optimization
- Authorization management
- Faster workers comp payment collection
Specialized Services
Surgical Procedure Billing
Expert coding for joint replacement, arthroscopy, fracture repair, and spinal surgeries with global period management.
- Joint replacement (27447, 27130)
- Arthroscopic procedures
- Fracture repair (ORIF/CRIF)
- Spinal fusion procedures
Injection & In-Office Procedures
Accurate billing for joint injections, trigger point injections, and in-office geriatric procedures.
- Joint injections (20610-20611)
- Trigger point injections
- Bursa aspirations
- Casting and splinting
Imaging & Diagnostic Services
Complete billing support for in-office X-rays, ultrasound, and other diagnostic imaging with proper component coding.
- X-ray technical/professional split
- Ultrasound guidance (76942)
- Users density scanning
- Modifier 26 and TC application
Hardware & Implant Billing
Specialized billing for geriatric implants, plates, screws, prosthetics, and surgical hardware.
- Implant HCPCS codes
- Manufacturer documentation
- Prosthetic device billing
- Hardware removal procedures
Common CPT Codes Reference
Key codes include G0438 (Annual wellness visit — initial (Medicare)), G0439 (Annual wellness visit — subsequent (Medicare)), 99483 (Assessment and care planning for cognitive impairment), 99497 (Advance care planning, first 30 min), 99498 (Advance care planning, each additional 30 min), 99490 (CCM, first 20 min per month), 99213 (Office visit, established patient, 20–29 min), 99215 (Office visit, established patient, 40–54 min), 97110 (Therapeutic exercises — 15 min), G0180 (Physician certification for home health care services). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.
Expert Billing Insights
Dementia Care Planning and Cognitive Assessment Billing
The comprehensive dementia care planning code (99483) is one of the highest-value E/M codes in outpatient geriatrics, paying approximately $282–$355 per encounter. This code requires a comprehensive cognitive assessment using a validated tool (MMSE, MoCA, or equivalent), evaluation of safety, neuropsychiatric symptoms, and care needs, and development of a care plan that is communicated to the patient and family. It includes at least 50 minutes of total physician time but can also be supported by medical decision-making criteria. Many geriatrics practices are not billing 99483 despite regularly performing these assessments.
- 99483 requires: validated cognitive assessment, safety evaluation, neuropsychiatric review, care plan
- Document total time if using time-based billing — minimum 50 minutes for 99483
- Cannot be billed same day as an E/M visit — must be its own encounter
- Caregiver counseling within 99483 session is included — do not bill separately
Advance Care Planning: Legal, Ethical, and Billing Framework
Advance care planning (ACP) codes (99497/99498) reimburse physicians for time spent discussing advance directives, POLST forms, healthcare proxy designations, and end-of-life care preferences with patients and families. These discussions are critically important in geriatrics and are frequently performed but rarely billed. ACP can be billed on the same date as an E/M visit with modifier 25, or as a standalone service. Medicare covers ACP without patient cost-sharing when billed as part of the AWV.
- ACP can be billed with E/M using modifier 25 — or as standalone on separate date
- Document who was present, topics discussed, documents completed, and patient wishes
- Medicare: zero patient cost-share for ACP when billed as part of AWV (G0439)
- 99497 requires at least 16 minutes of physician-led ACP discussion
Geriatric Falls Prevention and Functional Assessment Billing
Fall risk assessment and prevention is a quality measure and a billing opportunity in geriatric medicine. Validated fall risk tools (Timed Up and Go, Berg Balance Scale) can be documented and billed. Physical therapy referrals for balance and strengthening are separately managed by PT providers. In-office balance assessments using vestibular or functional testing codes support higher E/M complexity. Geriatric pharmacology reviews (deprescribing of high-risk medications) document data complexity for MDM billing.
- Document fall risk assessment at every geriatric visit — required for MIPS quality measures
- TUG test documented in chart supports functional assessment billing (97750)
- High-risk medication review (Beers Criteria): document medications reviewed and changes made
- Annual screening for depression (PHQ-2/9) at AWV supports mental health billing pathway
Payer-Specific Billing Tips
Medicare Part B
- AWV (G0438/G0439): zero patient cost-share — high scheduling compliance in Medicare population
- 99483 (dementia care planning): separate from AWV — schedule as standalone or next visit
- MIPS geriatric quality measures: dementia cognitive assessment, fall risk screening, depression screening
- Dual-eligible (Medicare + Medicaid) patients: Medicare primary, Medicaid may cover cost-shares
Medicaid
- Dual-eligible: coordinate Medicare and Medicaid benefits — Medicaid may wrap around Medicare
- Long-term care Medicaid: nursing home residents have specific billing rules (consolidated billing)
- Home- and community-based waivers: geriatric care management may be waiver-funded
- Medicaid LTSS (Long-Term Services and Supports): coordination with geriatric practice billing
Medicare Advantage Plans
- MA plans often cover additional geriatric benefits (hearing, vision, dental) beyond traditional Medicare
- HEDIS/STARS quality measures for MA plans drive bonus payments — document falls, dementia, depression
- MA prior auth may be required for specialist referrals from PCP
- Risk adjustment under MA: thorough HCC coding for frailty, dementia, and comorbidities is critical
Home Health and SNF Coordination
- Home health certification (G0180): $25–50 per certification — frequently overlooked revenue
- SNF discharge planning: TCM codes (99495/99496) billable within 30 days of SNF discharge
- Hospice patients: attending physician may still bill for unrelated medical conditions
- Palliative care consultation: separate from hospice billing — appropriate in serious illness pre-hospice
Related Billing Resources
Key Services
- geriatrics billing
- senior care billing
- elderly care billing
- geriatrician billing services
- aging care billing
Contact Medtransic today for expert geriatrics billing services. Call 888-777-0860 or visit https://medtransic.com/contact for a free consultation.