General Practice CPT Reference

General Practice CPT Codes and Reimbursement Rates

General practice billing covers the full breadth of primary care CPT codes, including E/M encounters across all complexity levels, preventive medicine services, chronic care management, and a wide range of in-office procedures.

Reviewed by MMBS Billing Review Team Last updated Mar 31, 2026 Published Mar 16, 2026
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General Practice CPT Codes and Reimbursement Rates
01

99213 (~$80-$100) is the most commonly billed code in general practice for established patients

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E/M level selection is based on MDM complexity or total time under 2021 guidelines

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CCM (99490) generates $100K-$120K/year for a practice with 200 eligible patients

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Preventive visits can be billed with a separate E/M code using modifier 25 for distinct problems

Overview

Why General Practice CPT Codes Teams Need a Better Workflow

General practice billing covers the full breadth of primary care CPT codes, including E/M encounters across all complexity levels, preventive medicine services, chronic care management, and a wide range of in-office procedures. The diversity of services billed daily demands coding versatility from every member of the billing team.

This reference organizes the most frequently used general practice CPT codes by service type. Each section covers E/M documentation requirements, preventive visit coding rules, procedural codes for common office-based treatments, and the add-on codes that general practitioners often underutilize.

Why General Practice CPT Codes Teams Need a Better Workflow
Challenges

Common General Practice CPT Codes Challenges We Solve

Every General Practice CPT Codes team deals with payer delays, coding nuance, and collection leakage.

99213 (~$80-$100) is the most commonly billed code in general practice for established patients

The workflow has to support this issue before claim submission, or it turns into avoidable rework after the payer responds.

E/M level selection is based on MDM complexity or total time under 2021 guidelines

When this area is inconsistent, denial rate, payment timing, and staff follow-up effort all get worse at the same time.

CCM (99490) generates $100K-$120K/year for a practice with 200 eligible patients

Tight documentation and coding controls here usually improve both reimbursement accuracy and operational speed.

Preventive visits can be billed with a separate E/M code using modifier 25 for distinct problems

This is one of the first places revenue leakage shows up when specialty billing habits are not standardized.

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Guide

The Complete Guide to General Practice CPT Codes

Quick answer

General practice billing covers the full breadth of primary care CPT codes, including E/M encounters across all complexity levels, preventive medicine services, chronic care management, and a wide range of in-office procedures. The diversity of services billed daily demands coding versatility from every member of the billing team.

This reference organizes the most frequently used general practice CPT codes by service type. Each section covers E/M documentation requirements, preventive visit coding rules, procedural codes for common office-based treatments, and the add-on codes that general practitioners often underutilize.

General Practice CPT Code Framework

General practice billing covers the broadest range of CPT codes in medicine. A general practitioner sees patients across all age groups, manages acute and chronic conditions, performs minor office procedures, and provides preventive care. The CPT code structure for general practice is anchored by evaluation and management (E/M) codes for office visits, supplemented by preventive medicine codes, chronic care management codes, and minor procedure codes. Mastering E/M level selection under the 2021 revised guidelines is the single most important billing skill for a general practice because office visits generate 70% to 80% of total practice revenue.

The 2021 E/M coding changes eliminated the history and physical exam requirements for code level selection. Under the current guidelines, the E/M level is determined by either medical decision making (MDM) complexity or total time spent on the encounter (including non-face-to-face time on the same day). This change simplified documentation but requires general practitioners to understand how MDM is scored across three elements: number and complexity of problems addressed, amount and complexity of data reviewed, and risk of complications or morbidity.

Office Visit E/M Codes (99202-99215)

New patient office visits use codes 99202 through 99205. Code 99202 (straightforward MDM, approximately $75 to $95) covers single, self-limited problems like acute pharyngitis or simple laceration evaluation. Code 99203 (low MDM, approximately $110 to $140) covers new patients with 2 to 3 minor problems or one chronic condition. Code 99204 (moderate MDM, approximately $170 to $210) applies when the assessment involves multiple chronic conditions or a new problem requiring additional workup. Code 99205 (high MDM, approximately $225 to $275) is reserved for new patients with severe or complex conditions requiring urgent decision-making.

Established patient visits use codes 99211 through 99215. Code 99211 (approximately $25 to $35) is the nurse visit code, used when the physician does not see the patient. Code 99212 (straightforward MDM, approximately $50 to $65) covers simple follow-up visits. Code 99213 (low MDM, approximately $80 to $100) is the most commonly billed code in general practice, covering patients with 2 to 3 stable chronic conditions or one acute uncomplicated illness. Code 99214 (moderate MDM, approximately $120 to $150) applies when multiple chronic conditions require adjustment or a new problem needs workup. Code 99215 (high MDM, approximately $175 to $215) covers complex patients with exacerbations or new severe diagnoses.

Preventive Visit Codes (99381-99397)

Preventive medicine codes are age-stratified. New patient preventive visits: 99381 (infant, under 1 year), 99382 (1-4 years), 99383 (5-11 years), 99384 (12-17 years), 99385 (18-39 years), 99386 (40-64 years), 99387 (65+ years). Established patient preventive visits: 99391 through 99397 following the same age brackets. Reimbursement ranges from $100 to $200 depending on the age group and payer. For Medicare patients, the Annual Wellness Visit (G0438 for initial, G0439 for subsequent) replaces the standard preventive codes and reimburses approximately $170 to $180. A preventive visit that also addresses a new or chronic problem can be billed with a separate E/M code using modifier 25, provided the E/M documentation supports a distinct service.

Minor Procedure Codes

General practitioners frequently perform minor office procedures. Incision and drainage of abscess (10060 for simple, approximately $150 to $200; 10061 for complicated, approximately $250 to $350) is among the most common. Skin biopsy codes changed in 2019: 11102 (tangential biopsy, first lesion, approximately $100 to $130) and 11103 (each additional lesion, approximately $60 to $80) replace the old 11100 series. Shave removal of skin lesion (11300-11313, approximately $80 to $150 depending on size and location) and destruction of benign lesions (17110 for up to 14 lesions, approximately $100 to $130) are common office procedures. Always bill the E/M visit with modifier 25 when a separately identifiable evaluation leads to the decision to perform the procedure.

Chronic Care Management (99490)

Chronic care management (CCM) code 99490 reimburses approximately $42 to $50 per month for 20 minutes of clinical staff time managing patients with two or more chronic conditions. Code 99491 (30 minutes of physician/qualified healthcare professional time, approximately $85 to $100 per month) reimburses at a higher rate for physician-directed CCM. The CCM revenue opportunity for general practice is substantial: a practice with 200 eligible CCM patients billing 99490 monthly generates $100,000 to $120,000 in annual CCM revenue. Eligible patients must have two or more chronic conditions expected to last at least 12 months, and the practice must obtain written patient consent before billing.

Common General Practice CPT Codes

CPT Code Description Reimbursement Range
99213 Established patient, low MDM $80 - $100
99214 Established patient, moderate MDM $120 - $150
99203 New patient, low MDM $110 - $140
99396 Preventive visit, established, age 40-64 $140 - $175
99490 Chronic care management, 20 min/month $42 - $50/month
10060 I&D of abscess, simple $150 - $200

Official sources

Use these checks with payer policy, coding documentation, and remittance data before changing claim workflows.

Common Questions

General Practice CPT Codes FAQ

Answers to the questions practice owners ask most often.

The distinction hinges on medical decision making complexity. Code 99213 requires low MDM: 2 or more self-limited or minor problems, or 1 chronic illness with no exacerbation. Code 99214 requires moderate MDM: 1 or more chronic illnesses with exacerbation, 2 or more chronic conditions requiring medication management, or 1 new problem requiring additional workup. If the patient has diabetes with a medication change plus hypertension being adjusted, that qualifies as moderate MDM (99214). Stable diabetes on the same medication with routine refill is low MDM (99213).

Yes. Bill the preventive visit code (99391-99397 or G0438/G0439 for Medicare) and the appropriate E/M code (99212-99215) with modifier 25 appended to the E/M code. The E/M documentation must support a separately identifiable problem that was addressed beyond the scope of the preventive visit. For example, a patient comes for an annual physical and also reports new knee pain that requires evaluation and treatment. The knee evaluation supports the separate E/M code. Document the problem-oriented visit in a separate note section.

The patient must have two or more chronic conditions expected to last at least 12 months and place the patient at significant risk of death, acute exacerbation, or functional decline. Common qualifying condition pairs include diabetes plus hypertension, COPD plus heart failure, or depression plus chronic pain. The practice must obtain written consent from the patient, provide 24/7 access to care, and document at least 20 minutes of clinical staff time per calendar month in non-face-to-face care coordination activities.

Use time-based coding when the total time spent on the encounter (face-to-face plus same-day non-face-to-face activities like reviewing records, ordering tests, coordinating care) supports a higher E/M level than the MDM complexity alone. For 99214, the time threshold is 30 to 39 minutes total. For 99215, it is 40 to 54 minutes. Time-based coding is especially useful for complex care coordination encounters where the MDM may not be high but the physician spends significant time on the phone with specialists, reviewing outside records, or counseling the patient and family.

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