Geriatrics billing services
Billing for geriatricians and senior care practices that see patients in the office, in nursing facilities and at home, with Medicare's care planning codes captured.
Why geriatrics billing takes specialty knowledge
Geriatric practices bill mostly to Medicare and Medicare Advantage, and they work across more places of service than almost any other specialty. Office visits, nursing facility rounds, assisted living visits and home calls each have their own code sets and place of service rules. On top of that, the services older patients need most, such as advance care planning, cognitive assessments, wellness visits and care management, are separately billable but easy to leave off the claim.
SFA Solutions bills geriatric services with the correct code family and place of service for each setting. We capture advance care planning and cognitive assessment when documented, waive cost sharing correctly when ACP is done with a wellness visit, track CCM and TCM time each month, and coordinate Medicare with secondary and Medicaid coverage so dual-eligible balances are billed to the right payer.
Common codes we work with in geriatrics
| Code | Description |
|---|---|
| 99304 | Initial nursing facility care, straightforward or low medical decision making |
| 99309 | Subsequent nursing facility care, moderate medical decision making |
| 99349 | Home or residence visit, established patient, moderate medical decision making |
| 99483 | Cognitive assessment and care plan services |
| 99497 | Advance care planning, first 30 minutes face-to-face |
| G0439 | Medicare annual wellness visit, subsequent |
| 99490 | Chronic care management, first 20 minutes of clinical staff time per month |
| 99496 | Transitional care management, high complexity, visit within 7 days of discharge |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where geriatrics practices lose revenue
The right code set for each setting
Nursing facility visits use 99304-99310, with discharge services 99315 and 99316, and place of service 31 for skilled nursing or 32 for nursing facilities. Since 2023, assisted living and other residential visits use the home or residence codes 99341-99350, with place of service 13 for assisted living. Billing an office code for a facility visit is an automatic denial.
Advance care planning
Advance care planning is billed with 99497 for the first 30 minutes and 99498 for each additional 30 minutes, and it can be done by physicians and NPs. When it is performed during an annual wellness visit and billed with modifier 33, Medicare waives the patient's deductible and coinsurance. Documentation must show the voluntary discussion and the time spent.
Cognitive assessment and care planning
99483 covers a cognitive assessment and care plan for a patient with cognitive impairment, including functional assessment, medication review, safety evaluation and caregiver needs. It requires a written care plan and can be billed by physicians and NPs. It can be done in the office, the home or a facility.
Dual-eligible and secondary billing
Many geriatric patients have Medicare and Medicaid or a Medicare supplement. Qualified Medicare Beneficiaries cannot be billed for Medicare cost sharing, so those balances must go to Medicaid or be written off. Crossover claims and secondary filing need to be checked to make sure each balance is actually collected.
What else affects geriatrics revenue
A/R challenges in geriatrics
Geriatric A/R is driven by secondary and crossover balances. After Medicare pays, the remainder may cross over automatically to a supplement or Medicaid, or it may need a separate claim with the Medicare EOB, and balances that did not cross over often go unnoticed. Patients also change Medicare Advantage plans during annual enrollment or move between traditional Medicare and MA, so January claims are frequently sent to the wrong payer. Hospice enrollment creates another trap, since services related to the terminal condition need modifier GV from the attending physician and unrelated services need GW.
Credentialing considerations
Geriatricians enroll under the geriatric medicine taxonomy for internal medicine (207RG0300X) or family medicine (207QG0300X). Providers who round in nursing facilities need privileges or approval from each facility, and those who bill dual-eligible patients need Medicaid enrollment to receive crossover payments. Home and domiciliary visits also need the correct service location on file with some payers.
Payer considerations
Most geriatric revenue comes from traditional Medicare and Medicare Advantage, and MA plans may require referrals or authorizations that traditional Medicare does not. Physician services in a skilled nursing facility are excluded from SNF consolidated billing, so they are billed to Part B even during a covered Part A stay. Patients who are Qualified Medicare Beneficiaries cannot be billed for Medicare cost sharing, and Medicaid's payment for that cost sharing may be limited by state rules.
Geriatrics coding details that affect payment
ICD-10 considerations
Dementia codes were expanded in 2022 to show severity and behavior, using F03.A0, F03.B0 and F03.C0 for mild, moderate and severe unspecified dementia, with further characters for agitation, psychotic disturbance and other behaviors. Alzheimer's disease is coded with G30 first and an F02 code for the dementia that goes with it. Falls risk is supported by Z91.81 (history of falling) and R26.81 (unsteadiness on feet), and pressure ulcers use L89 codes that state site and stage. For Medicare Advantage patients, chronic conditions such as CKD stage, heart failure type and diabetes complications need to be documented and coded at least once a year to count in risk adjustment.
Modifiers to watch
| GV | Used by the patient's attending physician who is not employed by the hospice when billing Part B for care related to the terminal condition. |
|---|---|
| GW | Applied to services unrelated to a hospice patient's terminal condition so Medicare processes them outside the hospice benefit. |
| 33 | Added to advance care planning done with the annual wellness visit so Medicare waives the patient's cost sharing. |
| 25 | Used on a problem visit billed the same day as an annual wellness visit or a minor procedure when the problem work is separately documented. |
Global periods
Global surgical periods rarely apply in geriatrics, since most services are visits and care management. A patient in a surgeon's 90-day global can still be seen by the geriatrician for unrelated chronic conditions, because the global only bundles the surgeon's own postoperative care.
Medicare considerations
In a skilled nursing facility, the initial comprehensive visit generally must be performed by a physician, and required visits then occur at least every 30 days for the first 90 days and every 60 days after that, with NPs allowed to alternate visits. Medicare pays 99483 no more than once every 180 days per patient. Patients often switch between traditional Medicare and Medicare Advantage during enrollment periods, so eligibility should be rechecked each January.
Geriatrics billing KPIs to track
- Crossover payment rate. Secondary and Medicaid crossover balances that never post are the most common loss in a Medicare-heavy panel.
- Place of service denial rate. Visits billed with the wrong code family or POS for the setting are denied outright, so this rate tracks setting accuracy.
- Advance care planning and cognitive assessment capture. Comparing billed ACP and 99483 services to documented discussions shows how much eligible work goes unbilled.
- January wrong-payer denials. Plan changes at the start of the year send claims to the wrong payer, and a spike shows eligibility was not rechecked.
Geriatrics billing audit checklist
- Confirm each facility visit uses the code family and place of service for that setting.
- Check ACP claims for documented time and voluntary consent, and modifier 33 when done with the AWV.
- Verify 99483 claims include all required elements and a written care plan.
- Review hospice patients' claims for the correct GV or GW modifier.
- Confirm QMB patients have not been billed for Medicare deductibles or coinsurance.
- Match Medicare payments to crossover or secondary payments and refile any balance that did not cross over.
How SFA runs geriatrics billing
We map each provider's places of service, including facilities, assisted living and home visits.
Visits are coded with the correct code set and POS, and ACP, cognitive assessment and wellness services are captured.
CCM and TCM time and deadlines are tracked monthly before claims are filed.
Primary, secondary and Medicaid crossover claims are followed until each balance is paid or properly adjusted.
The services that matter most for geriatrics
Medical Billing
Geriatric claims cross several places of service and need the right code family and POS for each setting.
Learn moreEligibility Verification & Prior Authorization
Medicare Advantage, Medicaid and supplement coverage change often for older patients and must be checked before each visit.
Learn moreA/R Recovery
Crossover and secondary balances are easy to miss and often sit unpaid without follow-up.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Geriatrics billing questions
Which codes do I use for assisted living visits?
Use the home or residence visit codes 99341-99350 with place of service 13. The separate domiciliary codes were deleted in 2023.
Does Medicare charge patients for advance care planning?
Normally the usual deductible and coinsurance apply. When ACP is provided on the same day as the annual wellness visit and billed with modifier 33, Medicare waives the patient's cost sharing.
Can an NP bill 99483?
Yes. Physicians and NPs, among other eligible practitioners, can bill 99483 when they perform and document all of the required elements and the written care plan.
Can I bill TCM for a patient discharged to a nursing facility?
TCM applies when the patient returns to a community setting such as home or assisted living. A patient discharged from the hospital to a skilled nursing facility is not eligible for TCM until they are discharged from the SNF to the community.
Can we bill dual-eligible patients for coinsurance?
Not if the patient is a Qualified Medicare Beneficiary. Federal law prohibits billing QMB patients for Medicare deductibles and coinsurance, so those amounts go to Medicaid or are adjusted off.
See what your geriatrics billing is missing
Send us a few details and an RCM specialist who knows geriatrics will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
- No commitment
Request your free practice audit
An RCM specialist typically replies within one business day.