The hidden revenue boosters: Overlooked billing codes that can increase your bottom line
Overlooked medical billing codes can drastically impact practice revenue. Use these strategies to prevent claim denials and maximize reimbursements.
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At a Glance
- Overlooked billing codes cost providers millions annually in lost revenue and claim denials.
- Key missed opportunities include care management, telehealth, and preventive service codes.
- Accurate coding requires staff training, routine audits, and specialized billing technology.
The Centers for Medicare & Medicaid Services (CMS) reported that in 2024, incorrect coding drove over half a billion dollars in errors involving Current Procedural Terminology (CPT) code 99214 alone. Suboptimal billing practices lead to costly insurance claim denials — 64% of clinics cite them as a primary challenge. Many denials stem from overlooked billing codes, resulting in unnecessary revenue loss.
Optimizing billing ensures a steady revenue flow, allowing clinicians to focus on patient care. In this article, we’ll explore overlooked billing codes and how they impact revenue — and uncover actionable strategies to ensure practices maximize reimbursement.
Why billing codes matter for revenue optimization
Billing codes serve as the foundation of the healthcare revenue cycle, translating patient care into reimbursable claims. Beyond ensuring reimbursement, precise coding reduces administrative burdens, preventing time-consuming claim rejections and appeals.
Each service — from routine checkups to complex procedures — requires precise coding to secure proper payment from insurers. Errors in coding result in underbilling, denials, or compliance penalties. When used correctly, billing codes not only ensure reimbursement but also capture all eligible billable services, optimizing financial performance.
Beyond revenue loss, missing codes create operational inefficiencies. Practices spend extra time correcting denied claims, resubmitting paperwork, and appealing decisions — all of which delay payments and strain cash flow. By proactively identifying and applying the right billing codes, practices can enhance financial stability and reduce administrative burdens.
| Leveraging advanced billing technology, like Tebra's automated eligibility checks, can proactively prevent claim denials, ensuring steady revenue while allowing providers to focus on patient care. Learn more here. |
Top overlooked billing codes that impact your bottom line
Billing codes bridge healthcare services and reimbursements, yet many practices fail to utilize all billable opportunities.
“Many practices provide ongoing care for patients with chronic conditions but fail to bill for it properly.”
Below are some of the most frequently overlooked codes that can significantly boost revenue when applied correctly.
1. Care management codes — Ongoing patient support
Many practices provide ongoing care for patients with chronic conditions but fail to bill for it properly. These billing codes ensure providers receive reimbursement for non-face-to-face care coordination:
- Chronic Care Management (CCM) (CPT 99490, 99491) — Monthly payments for managing patients with chronic conditions.
- Transitional Care Management (TCM) (CPT 99495, 99496) — Covers follow-up care after hospital discharge.
2. Preventive care services — Fully covered by insurance
Many preventive services are 100% covered by insurance, but if they’re not billed correctly, practices lose out.
- Annual Wellness Visits (AWV) (CPT G0438, G0439) — Medicare pays for yearly checkups.
- Immunization Administration (CPT 90460, 90461) — Providers can bill for giving vaccines, not just the vaccine itself.
- Health Screenings (CPT G0444 for depression, G0447 for obesity, 99406 for smoking cessation) — Many insurers cover these visits to catch health issues early.
3. Telehealth codes — Growing revenue stream
Virtual visits have surged since COVID-19, yet many providers fail to bill for them correctly, leaving money on the table. Using telehealth billing codes ensures providers receive reimbursement for remote care, enhancing revenue streams in an increasingly digital healthcare environment.
- Audio-Only Visits (CPT 98008-98015) — For non-Medicare patients. Medicare covers audio-only services as a telehealth service when it is documented that the patient does not consent to video, appended with modifier -93.
- Virtual Check-ins (HCPCS G2010, G2012) — Covers brief video or phone interactions that determine whether a face-to-face visit is warranted.
- Remote Patient Monitoring (CPT 99453, 99454, 99457, 99458) — Covers home-based monitoring of chronic patients via bio-technology devices.
| Create high-quality video visits, group appointments, dedicated provider URLs, virtual waiting rooms, and custom patient communications with Tebra’s HIPAA- and HITRUST-certified telehealth. |
4. Prolonged service codes — Get paid for extra time
If a provider spends more time with a patient than usual, they can bill for the extra minutes:
- CPT 99354, 99355 — For longer-than-expected visits.
- CPT 99358, 99359 — Covers record review and care coordination outside appointments.
- G2212, G0316, G0317, G0318 — Medicare
5. Behavioral health integration — Expanding mental health care
With rising mental health demands, these codes help providers bill for care coordination:
- Behavioral Health Integration (CPT 99484) — Primary care doctors can bill for managing mental health services.
- Collaborative Psychiatric Care (CPT 99492, 99493, 99494) — Covers time spent coordinating with specialists.
By integrating behavioral health billing into their practice, providers can diversify revenue streams while addressing critical patient needs.
The cost of overlooking key codes
Failing to properly capture all billable services doesn’t just mean lost revenue — it can lead to compliance issues, operational inefficiencies, and extra work for healthcare staff.
“Failing to properly capture all billable services doesn’t just mean lost revenue — it can lead to compliance issues, operational inefficiencies, and extra work for healthcare staff.”
Here’s how missing key billing codes affects a practice’s bottom line.
1. Revenue leakage — The hidden financial drain
Billing mistakes are one of the leading causes of revenue loss in healthcare — translating directly to lost revenue. Even small mistakes add up over time, creating substantial financial gaps. A mere 32.4% of denied preventive service claims are resubmitted by physicians, indicating that over two-thirds of such denied claims are never resubmitted.
Revenue impact example:
A practice that fails to bill Chronic Care Management (CCM) (CPT 99490) for just 10 Medicare patients per month could be missing out on over $12,000 per year in potential revenue.
Similarly, underutilizing prolonged service codes (CPT 99354, 99355) — which reimburse providers for extended visits — can lead to thousands of dollars in lost revenue annually.
Industry data:
- Medical billing denials cost US healthcare providers nearly $20 billion annually.
- Up to 40% of initial claim denials occur due to coding, eligibility, or documentation errors.
2. Compliance risks — Avoidable audits and penalties
Medical billing errors can trigger audits, penalties, and legal repercussions. Insurance providers and government payers like Medicare regularly review claims for errors and inconsistencies.
- Upcoding (billing for more expensive services than performed) can result in fraud investigations and severe fines.
- Underbilling (failing to charge for services provided) not only leads to lost revenue but also raises red flags in audits for inconsistencies in billing patterns.
- Frequent errors or incorrect coding can put a practice under scrutiny, leading to time-consuming audits that disrupt operations.
3. Operational inefficiencies — More work, slower payments
Denied claims don’t just mean lost money — they create extra work for billing teams, slowing down cash flow and increasing administrative costs.
“Automating billing processes and ensuring accurate coding reduces claim denials, improves efficiency, and speeds up reimbursement.”
Conversely, automating billing processes and ensuring accurate coding reduces claim denials, improves efficiency, and speeds up reimbursement. Many of these financial risks can be avoided with proper billing training, regular audits, and technology-driven solutions.
Tebra’s billing tools help providers capture all billable services, reduce claim rejections, and streamline reimbursements. By implementing proactive billing strategies, leveraging automation, and investing in staff education, practices can significantly improve revenue flow and operational efficiency.
Strategies to prevent claim denials and improve billing accuracy
Even with optimized billing codes, claim denials remain a persistent challenge for healthcare providers. Understanding the most common reasons claims are rejected can help practices identify patterns, correct errors proactively, and improve reimbursement rates.
1. Use modifiers correctly (CO 4, CO 16)
✔ Issue: Incomplete or incorrect modifier usage results in rejected claims.
✔ Fix: Conduct regular coding audits and train staff on proper modifier application.
✔ Solution: Use billing software that flags missing or incorrect modifiers before submission.
2. Match services with correct codes (CO 11, CO 97)
✔ Issue: Insurance payers reject claims with mismatched diagnosis and procedure codes.
✔ Fix: Keep CPT and ICD-10 coding lists updated and cross-check codes before submission. Review any payer-specific coverage policies regularly for updates and coverage requirements.
3. Prevent duplicate claims (CO 18)
✔ Issue: Insurance companies flag duplicates as errors, even when services were provided.
✔ Fix: Use automated billing systems to track claims and prevent duplicate submissions.
4. Verify insurance eligibility before appointments (CO 22, CO 27, CO 167)
✔ Issue: Incorrect patient insurance information leads to coverage-related denials.
✔ Fix: Perform real-time eligibility checks before appointments to confirm coverage.
5. Submit claims on time (CO 29)
✔ Issue: Late submissions prevent reimbursement.
✔ Fix: Implement a tracking system to flag claims nearing deadlines.
6. Monitor fee schedules (CO 45)
✔ Issue: Insurers won’t reimburse amounts that exceed fee schedules.
✔ Fix: This is a denial code you want to receive. If you aren't getting CO 45, then your pricing is likely not set high enough. Payers will not reimburse over the charge amount, so if the provider's price is lower than what could be reimbursed, they are missing reimbursement.
Stay updated on payer fee schedules and ensure you are charging the correct amount for your services.
Best practices for optimizing medical billing accuracy
To maintain coding accuracy and improve revenue flow, practices should:
- Conduct routine coding audits — Regularly review claims and reimbursement reports to catch errors early.
- Establish a robust collections process — Implement clear policies for managing patient payments and insurance claims.
- Train and educate staff — Provide ongoing training on the latest CPT and ICD-10 updates, payer rules, and compliance requirements. Conduct quarterly refresher courses to minimize coding errors.
- Address denied claims quickly — Set up an efficient process for correcting and resubmitting denied or rejected claims.
- Leverage medical billing software — Automate coding accuracy checks, eligibility verification, and claim tracking to reduce errors and speed up payments.
The role of technology in ensuring coding accuracy
Overlooked billing codes, claim denials, and preventable coding errors result in millions of dollars in lost revenue every year. Maximizing revenue starts with a smarter, more strategic approach. Now’s the time to take action — review your billing procedures, identify missing revenue opportunities, and implement solutions that drive long-term financial success.
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Crack the code for beating medical billing challenges with this free workbook — which provides tips around improving patient collections, streamlining claims submissions, and reducing rejections and denials.
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