Unlocking Revenue with Underused Medicare Codes in Primary Care

Primary care physicians often provide critical services such as counseling, care coordination, and post-discharge follow-up that are not fully captured in traditional billing claims. To address this, Medicare has introduced various CPT and HCPCS codes over the past decade intended to compensate for these efforts more accurately. Despite broad coverage on paper, these codes are significantly underused in practice, leading to missed revenue opportunities for practices, particularly small and independent ones. Research indicates low utilization rates for these prevention and care coordination codes. For instance, cognitive assessment and care planning services for Alzheimer's patients reach only about 2.4% of eligible traditional Medicare beneficiaries, as reported by the Government Accountability Office. This underlines a gap between the availability of billing codes and their practical adoption. This article outlines 10 commonly underused billing codes within traditional Medicare that primary care practices can leverage. These include depression screening, chronic care management (CCM), transitional care management (TCM), advance care planning, cognitive assessment, and behavioral health integration. While the article emphasizes these codes are not easy revenue sources, they reflect a critical alignment between primary care activities and reimbursement structures. Implementing these codes requires adherence to documentation, supervision, and workflow requirements, which may demand operational adjustments within practices. The recommendation for practices, especially those with resource constraints, is to adopt an incremental approach by selecting one or two relevant service codes aligned with their patient demographics and building sustainable workflows around them. Incremental adoption not only fosters compliance but also ensures that primary care providers stop delivering considerable high-value care without compensation. This strategic approach can help stabilize practice revenue and highlight the importance of care coordination and preventive services in value-based care models. Overall, the effective utilization of Medicare’s care coordination and preventive service codes offers a pathway for primary care providers to better capture the scope of their work while improving revenue streams. Awareness and operational readiness are key to tapping into these underutilized reimbursement avenues.