Coding, claims and collections for independent physician practices, single-specialty and multispecialty groups, and physicians who also round in hospitals and ASCs, inside the systems you already run.
Physician revenue leaks in small amounts that repeat every clinic day: a problem visit billed with a same-day procedure but no modifier 25, a G2211 add-on left off a longitudinal visit, an NP follow-up billed under the wrong NPI, or a new doctor seeing Medicare patients before enrollment takes effect. One unpaid 99214 is $135.61 at the 2026 Medicare national office rate. Luxen codes each visit to documented MDM or time, checks every professional claim before release and works denials inside the EHR your physicians already use.
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Physician billing services code, submit and collect professional claims for office visits, procedures, hospital care and surgery, billed on the 837P under each physician's NPI. In 2026 the Medicare national amount for a moderate established office visit (99214) is $135.61 before geographic adjustment, and Medicare pays 80% after the Part B deductible.
Every physician practice bills professional claims, but the rules that cost money change with the practice model.
In-office procedures and diagnostics, hospital and ED visits, surgery performed in ASCs, telehealth, chronic care management (99490) and advanced primary care management (G0556 to G0558), all run by our full-service medical billing team.
Physician revenue is lost where the note, the provider roster and the claim disagree. Dollar figures are 2026 Medicare national non-facility amounts at the $33.4009 conversion factor, before geographic adjustment. Luxen findings come from the Luxen claim audit and Luxen billing reviews.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Problem visit and a same-day minor procedure | 99213 with modifier 25 | Modifier 25 left off, so the visit bundles into the procedure | $95.19 per visit | Coding and modifier errors caused 21% of denials |
| Longitudinal established visit | 99214 plus G2211 | Add-on never added for the ongoing primary or serious condition | $17.37 per visit | G2211 was missing on 27% of eligible established Medicare office visits, across 8,400 physician group claims |
| NP sees a new problem alone | 99214 | Billed incident-to under the physician instead of the NP at 85% | $20.34 overpayment per visit | 9% of NP and PA visits billed under a physician NPI did not meet incident-to rules |
| New patient with changed coverage | 99204 | Plan not verified before the visit | $177.36 per claim | Eligibility and coverage errors caused 24% of denials |
| Payer re-credentialing date missed | 99214 and all visits | Claims deny or hold until the file is reinstated | $135.61 per held 99214 | A lapsed re-credentialing held payments for a median of 47 days |
| Rejected claim left in a queue | 99215 | Medicare filing limit of one calendar year passes | $192.39 per claim | Timely filing caused 6% of denials, and only 4% of those were recovered |
Physicians bill professional services on the 837P or paper CMS-1500. Hospitals and ASCs bill the facility side on the 837I or UB-04 (CMS-1450) (CMS MLN006976). When a physician sees a patient in a hospital outpatient clinic, the same visit produces two claims, and the professional claim pays less.
Medicare pays the non-facility rate for place of service 11 (office) and the lower facility rate for POS 19 and 22 (off-campus and on-campus outpatient hospital), 21 (inpatient), 23 (emergency room), 24 (ASC) and 02 (telehealth outside the home) (Claims Processing Manual, Chapter 12, section 20.4.2).
| Code | Office, POS 11 | Hospital outpatient, POS 19 or 22 | Difference |
|---|---|---|---|
| 99213 | $95.19 | $57.45 | $37.74 |
| 99214 | $135.61 | $84.50 | $51.11 |
| 99204 | $177.36 | $116.90 | $60.46 |
| 99215 | $192.39 | $125.59 | $66.80 |
A hospital-owned clinic that sends POS 11 on physician claims is paid the office rate in error, and the difference becomes an overpayment to refund.
Every surgical code carries a global period in the fee schedule (CMS MLN907166):
| Modifier | When it applies |
|---|---|
| 24 | Unrelated E/M visit during a postoperative period |
| 25 | Significant, separately identifiable E/M on the day of a minor procedure |
| 57 | E/M where the decision for major surgery was made, the day before or day of surgery |
| 58 | Staged or related procedure during the global period |
| 78 | Unplanned return to the operating room |
| 79 | Unrelated procedure during the global period |
Without 24, 25 or 57, the visit is treated as part of the surgical package and pays nothing.
Office visits are leveled by medical decision making (MDM) or by total practitioner time on the date of the encounter, whichever the documentation better supports (2024 E/M reference guide; AMA CPT 99214). Our certified medical coding team levels each note against both.
| Code | MDM | Time met or exceeded | 2026 Medicare national, office |
|---|---|---|---|
| 99202 new | Straightforward | 15 min | $75.15 |
| 99203 new | Low | 30 min | $117.57 |
| 99204 new | Moderate | 45 min | $177.36 |
| 99205 new | High | 60 min | $236.81 |
| 99212 established | Straightforward | 10 min | $59.45 |
| 99213 established | Low | 20 min | $95.19 |
| 99214 established | Moderate | 30 min | $135.61 |
| 99215 established | High | 40 min | $192.39 |
Time counts only the physician or qualified professional. Nurse rooming, intake and scheduling time does not count.
G2211 pays $17.37 in the office when the physician is the continuing focal point for a patient's care or treats a single serious or complex condition over time. Since January 1, 2025, Medicare pays it on a visit with modifier 25 only when the same-day service is an annual wellness visit, vaccine administration or a Part B preventive service (CMS MLN006764).
Medicare does not pay CPT 99417. It pays G2212, $34.07 per unit, starting at 69 minutes with 99215 and 89 minutes with 99205 (CMS MLN006764). Payers that follow CPT use 99417 from 55 minutes with 99215 and 75 minutes with 99205, so the same note needs a different code by payer.
Medicare stopped recognizing consultation codes on January 1, 2010 (CMS Transmittal 1875). A consult for a Medicare patient bills as a new or established office visit.
A new physician joining a group files the CMS-855I, which has included reassignment of benefits since CMS merged the CMS-855R into it in 2023 (CMS enrollment bulletin). Billing privileges start on the later of the filing date of an approved application or the date services began at the new location (42 CFR 424.520(d)), and the group can bill for services 30 days before that date (42 CFR 424.521(a)) (eCFR). Visits earlier than that window are not payable by Medicare.
Commercial credentialing runs on its own clock. Washington gives carriers 90 days to decide a complete application and requires determinations to average no more than 60 days (RCW 48.43.750), a rule we track on our Washington medical billing page. Most states set no deadline. Our provider credentialing team files Medicare, Medicaid and commercial applications before the start date. Credentialing lapses delayed payment for 1 in 12 providers added in the prior year (Luxen billing reviews).
| Situation | Bill under | Medicare pays |
|---|---|---|
| NP or PA follow-up on a physician-started plan, office, physician in the suite or on live video | Supervising physician | 100% of the fee schedule |
| NP or PA sees a new patient or a new problem | NP or PA | 85% of the fee schedule |
| NP or PA visit in a hospital or SNF | NP or PA, or split or shared | 85%, or 100% if the physician did the substantive portion |
Incident-to applies only outside hospitals and SNFs, and only when the physician started the course of treatment (42 CFR 410.26; Noridian). NPs and PAs billing under their own NPI are paid at 85% (42 CFR 414.56 and 414.52). From January 1, 2026, direct supervision by real-time audio and video is permanent, except for services with a 010 or 090 global period, and audio-only never counts (CY 2026 PFS final rule).
In hospital inpatient, outpatient, ED and SNF settings, a visit performed by a physician and an NP or PA in the same group bills under whoever did the substantive portion: more than half of total time or a substantive part of the MDM. Modifier FS is required. Office and nursing facility visits cannot be split or shared (CMS MLN006764).
Medicare stopped recognizing consultation codes on January 1, 2010 (CMS Transmittal 1875). A specialist seeing a referred Medicare patient in the office bills 99202 to 99215. Each consult claim denies, and the same denial repeats monthly when nobody tracks reasons: 63% could not name their top three denial reasons (Luxen Practice Manager Survey 2026).
Time-based office visit levels count only the physician or qualified professional's own time on the date of the encounter, not clinical staff time (AMA). A 99215 that falls back to 99214 on audit returns $56.78 per visit. Documented practitioner time did not support the time-based level on 7% of time-coded visits (Luxen claim audit).
Medicare pays G2211 on a modifier 25 visit only when the same-day service is an annual wellness visit, vaccine administration or a Part B preventive service (CMS MLN006764). Paired with a same-day procedure, the $17.37 add-on denies, and those denials rarely get worked: 19% of denied claims were never reworked or appealed (Luxen billing reviews).
Billing privileges start on the later of the approved application's filing date or the first date of service, with a 30-day look-back (42 CFR 424.520 and 424.521). A physician who sees Medicare patients for two months before filing loses every visit outside that window, $177.36 per new patient visit. Credentialing lapses delayed payment for 1 in 12 providers added in the prior year (Luxen billing reviews).
A Medicare denial worth appealing needs a redetermination request within 120 days of receiving the notice (42 CFR 405.942). Resending the same claim unchanged creates a duplicate denial while that clock runs. Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting (Luxen claim audit).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the systems your physicians already use. No migration and no new screens for clinicians.
We sign the BAA before access and bill from the schedule, signed notes, charge entries and remittances your practice already produces, reconciling completed appointments against submitted claims each week.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
Luxen billing reviews, 410 practice billing reviews, Jan 2025 to Jun 2026:
Across six specialties, there was no consistent check between completed appointments and submitted professional claims. Luxen found 347 unbilled encounters and recovered $119,600 in the first 90 days.
Chief Operating Officer, independent physician group
Denials moved between staff members without a clear owner or next action. Luxen assigned every account by reason and deadline, reducing average denial resolution time from 34 days to 11.
Revenue Cycle Director, multi-specialty physician practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
| KPI | Why it matters | Luxen benchmark |
|---|---|---|
| Denials never worked | Low-dollar E/M denials get written off | 19% of denied claims were never reworked or appealed |
| Appeal overturn rate | Shows which denials are worth appealing | Appeals filed by Luxen were overturned 68% of the time |
| Underpayments | Contracted E/M rates are rarely checked line by line | Underpayments against contracted rates appeared on 7.8% of paid claims |
| AR ageing review | Old balances stop being worked | Practices that reviewed AR ageing monthly carried 12 fewer days in AR |
Commercial payment speed is state law. Texas requires PPO insurers to pay clean electronic claims within 30 days and paper claims within 45 (Texas Insurance Code 1301.103), covered on our Texas medical billing page. Our denial and AR recovery team reports these KPIs by payer and physician.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, depending on visit volume, number of physicians and locations, and payer mix. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Office visits and add-ons (99202 to 99215, G2211) | $96,000 | $2,880 | $5,760 |
| In-office procedures and diagnostics | $32,000 | $960 | $1,920 |
| Hospital, ED and ASC professional services | $22,400 | $672 | $1,344 |
| Telehealth and care management | $9,600 | $288 | $576 |
| Total | $160,000 | $4,800 | $9,600 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $12,640 (7.9% of collections) | $4,800 to $9,600 |
| Annual | $151,680 | $57,600 to $115,200 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews). This group collects $1.92M a year. Biller vacancy data: Luxen Practice Manager Survey 2026.
| Partner type | E/M and NPP rules | New provider enrollment | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Handled when someone has time | Built by your staff | Payroll and turnover |
| Generalist billing company | Standard E/M edits | Often an extra fee | Standard ageing reports | Often annual terms |
| Specialty billing company | Deep in one specialty, thin across a multispecialty roster | Varies | Varies | Varies, some charge setup fees |
| EHR vendor RCM | Built into vendor claim rules | Rarely included | Inside the vendor platform | Tied to the software contract |
| Luxen | Certified coders for E/M, G2211, incident-to and FS | Filed before the start date | By payer, physician and denial reason | Month to month, no setup or exit fee |
For a wider view of the market, compare medical billing companies.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
The physician documents the visit, a coder assigns CPT or HCPCS and ICD-10-CM codes, and the practice sends a professional claim on the 837P to the payer. For Medicare, the patient pays the $283 Part B deductible in 2026 and then 20% coinsurance, and Medicare pays the rest of the fee schedule amount. Denied claims are corrected or appealed, and a Medicare redetermination must be requested within 120 days.
Luxen charges 3% to 6% of collections, month to month, with no setup or exit fee. For a group collecting $160,000 a month that is $4,800 to $9,600. Fully loaded in-house billing cost 7.9% of collections for practices under $2M (Luxen billing reviews).
We sign the BAA first, then take over claims in about 2 weeks, working the oldest money before timely filing limits pass. Median time from signed BAA to first claims worked was 9 business days, and first recovered payments arrived a median of 17 days after work began (Luxen client data). You can leave with 30 days notice.
No. We work inside Epic, athenaOne, eClinicalWorks, NextGen, ModMed, AdvancedMD and other physician systems with user access you control. Of practice managers who changed EHR or practice management systems, 71% said collections dipped for at least six months after the switch (Luxen Practice Manager Survey 2026).
Yes, when the visit is significant and separately identifiable from the procedure, reported with modifier 25 on the E/M code. If the visit is where the decision for a major surgery with a 090 global period was made, on the day before or day of surgery, modifier 57 applies instead. Without either modifier, Medicare treats the visit as part of the surgical package.
Luxen datasets: client data (38 client practices, Jan 2024 to Jun 2026); billing reviews (410 practice billing reviews, Jan 2025 to Jun 2026); claim audit (61,400 claims audited, Jan 2025 to Jun 2026); Practice Manager Survey 2026 (286 practice managers, March 2026)
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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