The 10 most underused Medicare codes in primary care

Primary care physicians spend a lot of time doing work that doesn't show in claims: counseling, care coordination, postdischarge follow-up, behavioral health support.

Over the past decade, Medicare has created a series of Current Procedural Terminology) CPT and Healthcare Common Procedure Coding System (HCPCS) codes to pay for at least some of that effort.

On paper, these services are widely covered. In practice, they're often barely used.

Studies of “prevention and care coordination” codes — including depression screening, chronic care management, advance care planning and others — show that only a small fraction of eligible Medicare beneficiaries ever receive a billed service.

Cognitive assessment and care planning for patients with dementia, for example, reaches at most about 2.4% of traditional Medicare beneficiaries with an Alzheimer's disease diagnosis, according to a Government Accountability Office analysis.

For independent and small practices, this results in lost revenue and missed opportunities.

What follows is a practical, coding-accurate overview of 10 services that are commonly underused in primary care. The focus here is traditional Medicare; commercial and Medicaid plans may have different rules and rates, so every practice will still need to check local payer policies.

The bigger picture

None of these codes is a magic bullet, and none is “free money.” Each one comes with documentation requirements, supervision rules, time thresholds and/or workflow changes. But together, they represent something important: a way to align how primary care is paid with what primary care actually does.

For practices already stretched thin, the path forward is incremental. Pick one or two of these code families that fit your patient population — depression screening, transitional care management, chronic care management, cognitive assessment and behavioral health integration are good starting points — and build reliable workflows around them.

Once the team sees that the work is sustainable and compliant, you can decide whether to expand.

The key is not to chase every new billing opportunity, but to stop giving away high-value care for free.