Geriatrics Billing Services

Geriatric care is about the whole person. Visits cover falls, memory, medications, caregivers and goals of care, often across clinics, homes and nursing facilities. Most patients have Medicare, and many are in Medicare Advantage plans with their own rules.

That makes geriatrics billing very different from general adult care. Services such as cognitive assessments, advance care planning and care management are time-based and need careful notes. Visits in different places use different code families. Westmont Revenue Partners connects geriatric practices with vetted billing experts who understand Medicare programs for older adults and can help ensure the work you do is documented and billed correctly.

Who this is for

• Geriatricians and geriatric nurse practitioners
• Primary care practices with a large senior population
• Clinicians who round in nursing facilities and assisted living
• Practices that make house calls
• Memory care and cognitive clinics

What gets billed

• Office visits for new and established patients
• Medicare annual wellness visits
• Cognitive assessment and care planning
• Advance care planning
• Chronic care management
• Nursing facility visits
• Home visits
• Transitional care after hospital stays
• Fall risk and function reviews
• Medication reviews
• Caregiver-focused support, where covered

Commonly billed codes

Code	Type	What it covers
99204	CPT	New patient office visit, moderate level
99215	CPT	Established patient visit, high level
G2211	HCPCS	Add-on for ongoing, longitudinal care in some office visits
G0438	HCPCS	Medicare first annual wellness visit
G0439	HCPCS	Medicare subsequent annual wellness visit
99483	CPT	Cognitive assessment with a written care plan
99497	CPT	Advance care planning discussion
99490	CPT	Monthly chronic care management by clinical staff
99495	CPT	Follow-up care after discharge, moderate complexity
99307	CPT	Subsequent nursing facility visit, straightforward level
99308	CPT	Subsequent nursing facility visit, low level
99349	CPT	Established patient home visit, moderate level
I10	ICD-10-CM	High blood pressure without a more specific cause
E11.9	ICD-10-CM	Type 2 diabetes without complications

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in geriatrics

Wellness versus problem visits. An annual wellness visit is not a physical exam. Billers help clinics separate the wellness work from problem-focused care so each is billed when supported.

Cognitive care planning requirements. The cognitive assessment service needs specific elements, such as a standard tool and a written plan. Billers use a checklist so a claim goes out only when the note supports it.

Place-of-service accuracy. Office, home, assisted living and skilled nursing visits use different codes and place-of-service values. Billers check each claim against where the visit occurred.

Nursing facility rules. Medicare has rules on visit timing and who may bill in skilled facilities. Billers confirm the patient status and visit frequency before claims are sent.

Medicare Advantage differences. Plans may require approvals, specific networks and different documentation. Billers keep plan-by-plan notes and watch for retroactive coverage changes.

Care management overlap. Some care management services cannot be billed together in a month. Billers track enrollment so patients are not billed under conflicting programs.

Capturing frailty and complexity. Visits for frail patients take time and judgment. Billers help providers document total time and decision making so the visit level matches the work.

How Westmont can help

• Matching you with vetted billing experts experienced in geriatrics and Medicare
• End-to-end revenue cycle support across office, home and facility settings
• Denial management for wellness, cognitive and care management claims
• Credentialing and enrollment help for providers and new sites
• Support for Medicare Advantage claims and appeals

Frequently asked questions

What makes geriatrics billing different?

Geriatrics billing covers many care settings and Medicare-specific services, such as wellness visits, cognitive assessments and advance care planning. Visits can be at a clinic, a home or a facility, each with different codes. A biller who knows Medicare rules for older adults can reduce denials and missed charges.

Does Medicare pay for cognitive assessment and care planning?

Medicare generally covers it as a separate service when the required elements are documented, including a structured assessment and a written plan. The rules are specific, and coverage varies by payer. Verify current-year Medicare policy and your payer's rules before building it into your visits.

Can I bill an annual wellness visit and a regular visit together?

Sometimes, if the regular visit addresses a separate problem that is documented on its own. Payers often ask for modifier 25 in that case. Keep the wellness elements separate from the problem work, and confirm each payer's policy. Check current-year Medicare guidance too, since wellness visit rules and frequency limits can change.

How do I bill for nursing facility visits?

Nursing facility visits use their own code family, and codes depend on visit type and level. Medicare has rules for how often visits are covered and who may bill them. Record the date, place of service and the reason for each visit, and check current-year Medicare guidance.

Is outsourcing geriatrics billing a good idea?

It can be, because geriatric billing involves many services, places and payer rules. Outsourcing may add coding review and consistent follow-up. It works best with clear documentation. Westmont can connect you with vetted billing experts so you can compare options.

Related billing services

• Internal Medicine
• Family Medicine
• Palliative Care
• Skilled Nursing Facilities / Nursing Homes
• Home Health Agencies
• Assisted Living / Long-Term Care