Background on Coding Changes

• In 2021, the American Medical Association (AMA) updated the coding guidelines and requirements for office visit documentation and billing.
• These updates require providers to base their billing on either the total time spent with a patient or the complexity of the medical decision-making involved.
• The goal of these changes is to improve clarity, support more accurate billing, and reduce uncompensated care.

Annual Physicals vs. Office Visits


Traditionally, an annual physical (also called a wellness visit or preventive visit) was handled separately from an office visit that addressed medical problems. Under the updated guidelines, providers may now bill both services on the same day if certain conditions are met:

• Preventive Care (Annual Physical): Focused on routine health screenings, preventive counseling, and wellness planning. Often covered by insurance at 100%.
• Problem-Focused Office Visit (E/M Service): Used when a provider addresses a specific, significant medical concern (for example, high blood pressure, diabetes, new symptoms, or ongoing health conditions).

How This Affects You

• If your provider addresses only preventive care during your visit, you will be billed for the annual physical.
• If your provider also evaluates and manages a medical concern during your physical, you may see two charges:
  • The preventive service (annual physical) — typically covered in full by most insurances.
  • A problem-focused office visit (E/M code 99202–99215) — which may require a copay, coinsurance, or may be applied to your deductible, depending on your insurance plan.

Why This Matters

• These updates encourage providers to address medical issues at the time of your physical instead of delaying care.
• This results in more comprehensive and timely care for you, while still complying with coding guidelines.

Key Takeaway


It is possible to receive two separate charges for a single appointment if your provider delivers both preventive and problem-focused care. We recommend checking with your insurance company to better understand how these services are covered under your plan.

​You will receive a copy of your bill. After your insurance has paid, we’ll provide you with a monthly statement of your account.

Generally, it takes from 45 to 60 days to obtain payment from an insurance carrier.​

​If we have received any such information from your insurance company, we’ll be glad to share it with you. However, for answers to any questions about insurance payments, deductibles, or co-payments, you generally need to check with your insurance company.