Geriatrics billing
Medicare-heavy panels with CCM, AWVs, ACP, and chronic conditions everywhere — every specialty trap and opportunity, concentrated.
Geriatrics is where the gap between 'good biller' and 'specialty biller' shows up biggest — CCM and HCC alone often add 20%+ to revenue when done right.
Where revenue leaks
The geriatrics traps we see most
Patterns we run into across Geri practices in Texas. None are obvious from a 30,000-foot view of the practice — they show up only when someone's actually looking at every claim.
CCM workflow not built
Geriatrics panels almost universally qualify for CCM (2+ chronic conditions). At ~$60/month per patient, a 1,200-patient panel with 80% qualifying is leaving ~$700K/year on the table without a CCM workflow.
Advance Care Planning not billed
99497 ($85) for the first 30 minutes and 99498 ($75) for each additional 30 minutes — billable separately from E/M with proper documentation. Geriatrics has these conversations constantly without billing.
Hierarchical Condition Categories (HCC) gaps in Medicare Advantage
MA plans pay providers more for sicker patients via HCC risk scoring. Conditions need to be documented and coded annually to maintain the risk score. Missed HCC documentation = lower MA reimbursement next year.
Complex chronic CCM under-captured
99487/99489 (complex CCM) pays significantly more than 99490 for patients with comprehensive care plans. Geriatrics patients often qualify but are billed at the basic 99490 level.
Coding focus
Where our coders specialize
- AWV (G0438 initial, G0439 subsequent) + problem visit modifier 25
- CCM (99490 basic, 99491 30-min, 99487/99489 complex)
- ACP (99497, 99498)
- TCM (99495, 99496)
- Behavioral health integration (99492, 99493, 99494)
- HCC documentation strategies for Medicare Advantage
Texas payer notes
Local rules we navigate every day
- Medicare Advantage plans in Texas (Humana, Aetna, Cigna, WellCare, Devoted) all use HCC scoring — annual documentation refresh is critical
- Medicare LCDs for ACP/CCM require specific consent language
- Texas Medicaid STAR+PLUS for dual-eligibles has additional service requirements
Geri KPIs we track
Specialty-specific benchmarks
We tailor reporting per specialty — these are the metrics that matter most for geriatrics.
70%+
CCM enrollment of qualifying panel
85%+
AWV completion rate
tracked weekly
ACP capture rate
What's your geriatrics practice leaking?
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Other specialties we serve