Evaluating Primary Care Revenue Expansion Options

Patients and providers alike have been complaining about declining conditions for primary care in America for at least a decade or two now. Patients lament lack of diagnosis and resolution of chronic symptoms. Doctors and clinic owners struggle to stay focused on serving patients, as opposed to dealing with practice management in a billing regime in which so many CPT codes generate so little revenue, necessitating increasingly complex systems to handle it all. Overheads increase while patient satisfaction declines. Eventually, many primary care practices (and specialists like ENT, sleep, and ophthalmology) conclude that adding higher margin services without expanding staff or overhead is a path toward addressing both sides of the problem.

The question then becomes: which services? That answer is not easy to derive but in the end, it becomes quite apparent in Figure 1 comparing 25 primary care revenue enhancement opportunities by the size of the anticipated three year net return after necessary investment (value), against the size of that needed investment (risk), the number of procedures required to achieve that return (labor), and how many times a given patient must return to the clinic to complete the protocol (attrition, another form of risk). Fully understanding the derivation and credibility of that graph is the subject of this page.

Nuances and Challenges in Comparing Medical Service Economics

Broadly speaking, primary care providers seeking enhanced clinic revenue options that also address patient concerns tend to do so in three steps.

1. Get and prioritize advice on increasing practice revenue generally
2. Parse that list into operational and medical options.
3. Investigate and choose from among the medical options

Among the medical options, three variables are paramount. In no particular order, they are:

1. The size of the opportunity defined by number of currently un- or under-served patients whose condition could now be addressed.
2. Revenue to be generated from each addressable patient.
3. The investment prerequisite to generating that revenue.

Each of these variables contains crucial nuances. Opportunity means the prevalence of the condition in the general population and in the clinic’s own existing patient base, but that number isn’t helpful in cases where years of effort trying to harvest those opportunities have failed. In such instances, the opportunity is illusory.

Different denominators

Generated revenue is measured and billed in multiple ways that confound comparisons because they use different denominators: per encounter, per unit, per test, per dose, and per unit time, for examples. In plainer English, published lists of revenue generating service options tend to compare apples, oranges, and goats. Each calculate differently, and some are additive while others are exclusive. Many lists report revenue only “per physician,” which creates a further, compounding problem. Does that include the other medical professionals like NPs, PAs, and MAs working under that single physician’s supervision? How many of each? How does one compare one clinic to another that way, in light of state-by-state variation in supervision regulations and clinic-by-clinic variation in staffing structures? The rankings must account for such variations by establishing a common denominator: revenue per 100 active patients.

Different investment requirements

Prerequisite investments differ in kind as well and must be harmonized for a proper ranking. Investment here means money spent to enable the service, not the consumables used in providing the service. Thus a urine analyzer (machine) is enabling, and considered and investment. The urine test strip or cartridge used for a single patient sample is not. For things like remote patient monitoring (RPM), investment includes the enabling software the clinic must use to manage the program, but not the monitoring device for each patient. For allergy, perhaps $100 to $200 spent on trays and wells for a skin test could be considered investment, if it weren’t so de minimus, while the allergens and applicators are consumable and are not, because they’re expended in single-patient use. Some revenue streams require capital investment up front while others don’t. Some require ongoing maintenance on top of capital, or subscription costs in lieu of capital, that may or may not vary by patient counts or usage.

Different degrees of patient demand

Finally, a ranking has to account for the accessible opportunity. That is, the return depends first on the size of the patient population that’s underserved—meaning in need of, eligible for, or desirous of the service, but not getting it. Then that underserved population has to be reduced by reasonably expected uptake, meaning the opportunity in practical terms is only as large as the subset of patients who can be persuaded to get the service at the offered price. It’s easy to persuade a patient with a broken bone to get an X-ray, and something approaching 100% percent of eligible patients will get one, though broken bones are less common than strep throats, for instance. It’s not nearly as easy to get patients to come in for annual wellness visits. In fact only about a third of patients actually get one, despite that truly everyone is eligible, they’re generally free to the patient, and years of effort have been expended trying to increase uptake.

Why Allergy Is Often Absent

Clinics thinking about and trying to rank their options will commonly not become cognizant of these distinctions, nuances, and challenges until they’re well down the road and realize that viable options were completely missed. There are a few reasons for the miss.

Well established, not new & hyped

ChatGPT explained that recommendations are "skewed toward newer growth categories, currently hyped areas" like GLP-1s and behavioral health, whereas “allergy testing is proven and established—which actually works against it in LLM recommendations that reward novelty.” Separately, ChatGPT said “conventional taxonomy” for LLM thinking on this subject “is mostly organized around billing categories, not around the economics of the patient population.” In other words, LLMs don’t naturally attempt to solve for opportunity size and uptake.

Unconsidered candidate

The most compelling explanation for allergy’s absence, however, comes from Claude, which explains it’s a category error based on the arrangement of the most authoritative data sets, such as CMS claims data. Prodded, other LLMs agree.

Consider how the process plays out behind the user interface. A doctor-owner might ask a large language model intelligence such as ChatGPT, Gemini, Claude, CoPilot, or Grok “what are the most lucrative services I can add to better serve my patients and increase primary clinic revenue?” We did that in October 2026 and found the model began the research by identifying available, relevant data from credible sources, such as CMS reimbursement rates, then sorted that list by ranking the most highly remunerated CPT codes, according to the number in a CMS table, without noticing that that sort assumes remuneration per encounter, or per test.

To illustrate, the model might start by sorting the CMS Physician Fee Schedule. Thus it would find that HCPCS (CPT) code 99205, complex new patient visit, bore a National Payment Amount Non Facility Price of $236.81 in October 2026. On the same list at the same time, 95004, allergy skin test was $3.67. The model ignores allergy accordingly, leaving it out of the candidate pool, despite that the visit price is billed once while the allergy price may be billed 78 times at once totaling $286.26, fully $50 and more than 20% higher than the complex visits.

In this way CCM or RPM often make the lists, and allergy doesn’t, despite that the various factors like opportunity size and uptake get applied to reduce the former below allergy’s return. Anything billed by the unit would unnoticed and unexamined in this way because the very structure of the initial, internal inquiry was fatally restricted by this unexamined assumptions phenomenon. Absent that phenomenon, when allergy is fully considered and the denominator and other nuances are reconciled, allergy comes out at or near the top.

The Most Common Revenue Advice Is Operational, Enhancing ALL Medical Options, so Choosing One or the Other Is Category Error

If the question is asked broadly—what can I do to enhance profitability—answers will nearly always start with operations, not medicine. Asking whether medical or operational enhancements are better for revenues, however, is a category error.

Recommended operational improvements will typically include filling the schedule, billing more codes for the same encounters, improving collections, and buying software or managed services to sustain those efficiencies. Clinics ought to do all of that regardless of whether they add service lines, too. The maximum revenue impact of such ops improvements is measurable, but is lower than prevalence of the advice might suggest. Each effort costs additional labor or investment to collect money the clinic is already owed, and efforts to close that gap have probably been underway in nearly every clinic for years by now. Nationally, 59.4% of established office visits already carry a level-4 or level-5 code, and first-submission denials have held at 7 to 8 percent through four years of everyone being told to fix them. A clinic may enhance revenues by between $3,750 and $5,750 per 100 active patients over three years, depending on visit volume, with maximal success across all these operational enhancements. That success doesn’t account for whatever investment in treasure and labor was necessary to achieve it, and must be compared to about $8,000 per 100 patients in additional revenue from allergy testing alone. More details in our discussion of operational approaches to coding, denials and no-shows. Sx link}

Trying to choose between operational and medical enhancements, meaning one or the other, is a category error because operational advice is multiplier for all of the clinic’s revenue streams. That is, ops improvements hit all the medicine, including new and old service lines. Maximizing efficiency tends to improve revenues, of course, and it can corrode the patients’ perceptions, too, which has the opposite effect on revenues. The more profitable a clinic’s service lines are, however, the lesser the pressure to turn & burn, creating more room to build patient/provider relationships by spending more time with patients, and thus enhance patient retention, and revenues. A optimal blend of operational efficiency and profitable service lines can thus have a mutually reinforcing effect.

Medical Service Options Break Neatly Into Four Categories on Two Questions

Narrowed to options that actually improve medicine as well, not just business, the answers shift to adding service lines, or enhancing services already on offer. Toward that end, the American Academy of Family Physicians observes that “each service [i]s a tributary to your practice's revenue stream” and advises that “procedures pay better than the evaluation and management (E/M) services” which tend to “take more time and pay significantly less than procedural services.” There are a lot to choose from.

Classifying revenue options by investment and demand requirements

Sorting the myriad service options available becomes easier when sorted by two dimensions into a quadrant.

1. Whether the service requires additional capability or capacity, such as new equipment or more staff, or can be done with investment in anything other than the consumables to be used in providing the service. A new saliva antigen test can be done easily with no additional equipment or personnel, for example, while new medical aesthetics procedures probably cannot. Clinics will need new equipment and probably trained aestheticians, which means at least a large investment in training existing staff, if not hiring new staff.
2. Whether the demand already exists in the clinic’s own patient population, or needs to be created. A new urine analyzer could certainly serve a large portion of existing patients, for instance, while a new cash pay HRT or GLP-1 program might not.

That breakdown is straightforward and intuitive. The four quadrants, or categories, further suggest the order in which clinics might evaluate or trial the options. If clinics haven’t done so already, the place to start is quadrant A, squeezing more revenue from existing medical activity with no new capability required. That’s not to imply those options are easy to execute, or guaranteed to succeed, or would suffice even if they did.

Next would be a look at quadrant B, increasing the amount of billable activity generated from the existing patient base without adding staff or other new capabilities. Unavoidably those options demand more of existing staff and/or present scheduling challenges. One of them, increasing annual wellness visits, on paper comprises one of the largest opportunities there is. More on that later.

Having considered the options that can be done with capabilities on hand, a clinic would then look to adding capability, such as new diagnostics and new patient or disease management programs. In this quadrant C lie some of the largest revenue opportunities, but not all of them. The rest of the really big ones are in quadrant D.

Only two high revenue options have existing demand needing no new investment: allergy & weight loss

Revenue enhancement options may be ruled in or out solely on the basis of which quadrant they’re in. If a clinic is limited or unable to make additional investments, or chooses to explore low/no investment options first, that choice rules out anything in quadrants B or D. The most lucrative options are nearly all in the yes|yes quadrant, D, meaning needing additional demand (more patients) and substantial investment (to recruit those patients and also pay for needed equipment or software). The exceptions are allergy and GLP-1 weight loss, for which large demand is already present in existing patients, no investment beyond consumables is required, and reimbursements per patient are tops. Searches by the big AI models seem to miss allergy testing anyway despite that it’s only done once, cannot lapse, has no attrition and has been reimbursed the same way for decades. By contrast, GLP-1 is a highly uncertain, unmeasured enterprise as discussed below.

The Real Differentiators of Medical Options Are Opportunity Size, Investment Required, and Risk on Return

Meaningfully parsing the options in quadrants C and D requires additional dimensions of analysis: the size of the revenue opportunity in dollars, the investment required to capture that opportunity, and the risks associated with the attempt. Assessment of the dollar value of course requires a meaningful common denominator. “Per physician,” which is frequently used as a denominator in such assessments, is problematic because physicians’ staffing strategies vary wildly, from MA-heavy with layers of PAs and NPs between, to physician only. How those differences are accounted for can vary in determining “per physician” numbers from option to option, meaning the denominator isn’t really common after all. Further, such differences can strongly impact how much revenue translates to real returns.

Reimbursable Medical Services Ranked by Revenues Over Three Years

There are roughly three dozen medical services that arise in an inquiry into revenue enhancing options for primary care. To compare them directly, it’s necessary to use revenue per 100 patients, or something similar, in order to control for variation in staffing models and payable measures (per test, visit, encounter, unit, etc.). The reimbursable opportunities are ranked as shown in Table 1.

Table 1 reflects best efforts to value the various options, in one of four different ways starting with whether market demand can be estimated. The four estimation methods are indicated by four bands: green, amber, red, and grey.

• Closable Opportunities: In this category, market demand is defined by the prevalence of a medical condition to be addressed. The opportunity, then, is the gap between the overall prevalence of that condition and the number of patients who actually getting diagnosis or treatment for it, as indicated by CMS claims data. A big gap between high prevalence and low testing or treatment indicates a big revenue opportunity. The opportunity value is calculated by the reimbursable value of the applicable service if supplied to all patients in the gap, less costs of equipment needed to provide the service. This green band contemplates serving only patients already active in the practice.
• Resistant Opportunities: Revenue options in the amber band are measured the same way as the ones in the green band, but in amber band there’s a history indicating concerted efforts to close the gap are prone to failure. To illustrate, the US Preventative Services Task Force has recommended for decades while Medicare has covered it and hundreds of millions have been invested in marketing, yet uptake peaked well below 30% and has since declined.^,23 Since then reimbursement rates fell so far below scanning machine prices that it’s untenable for most primary care settings.
• No Gap: Options in the red band are on the list because they’re often identified as services practices can add in order to enhance revenues, but analysis of medical prevalence of the condition to be addressed and CMS claims history indicate there are few patients needing that service who are not already getting it. That is, while a clinic’s own patient base may include patients with unaddressed needs in these medical areas, there’s reason to believe those patients are not numerous enough to represent a large revenue opportunity. It’s likely instead that either the clinic is currently referring such patients out, or the patients are finding the services on their own. The table accordingly values the revenue opportunity for such “no gap” services as the maximum a clinic would earn by recapturing the full amount of services at the rate patients receive it now. The red color of this band is intended to to indicate warning as such complete capture is unlikely, especially without a marketing budget that is not built into (subtracted from) the revenue estimation in this band.
• Unestimated: The grey band contains medical services for which diligent effort could produce no defensible estimate of need. Added capabilities like chest x-ray and an in-house moderate complexity lab could be used with a variety of conditions so broad that a use estimate would require arbitrary assumptions. Since actual use can’t be estimated, instead of a dollar figure the table indicates how many patients out of each 100 per year that the service would need to be billed for before that service brought in as much revenue as allergy testing. Allergy testing is the comparator because it’s the largest realistic (non-resistant) opportunity on the table. Clinicians will judge for themselves whether the usage requirements are realistic, which will depend largely on membership in larger organizations.

A handful of other somewhat commonly recommended service additions or operational changes are intentionally omitted. Adding behavioral health services, for instance, would require additional, specialized supervision or employees, and if that’s an open option, a clinic could just expand in a general sense, which is beyond the scope of this page. Encounter add-ons like advance care planning, depression or alcohol screening, and tobacco counseling add too little to merit focused attention. TCM applies to too narrow a patient set. In the Original Medicare program and claim set that forms the basis of this entire analysis, HCC recapture pays nothing. Capturing G2211 is not an addition at all, or at least it shouldn’t be. It’s essentially a refund of rate cuts already incurred in 2024 so practices not currently optimizing billings for it likely have more profound issues to address before adding more services

The opportunities that look largest are RPM, CCM/APCM, AWV, GLP-1 and allergy testing

By raw potential for additional revenue alone without substantial investment, the top four medical services to add are RPM, CCM/APCM, AWV, and allergy testing, in that order. For the uninitiated, the first three are remote patient monitoring, chronic care management, which strongly overlaps with advanced primary care management, and annual wellness visits.

Closer inspection of potential RPM and CCM revenues reveals they’re unrealistic or high risk

Revenue expectations must be tempered by certain realities, however. They depend first on whether there’s a sizeable gap between the prevalence of the condition to be treated (size of the market) and the number of patients already receiving treatment for it (market saturation, unmet demand). Where the remaining, unmet demand is unknown, the realism of the revenue opportunity falls accordingly.

Where a measurable, large, unmet demand does exist, and seems quite lucrative, the reality check is why that gap still exists. It might be resistant to closure, perhaps very resistant. One measure of such resistance is how long that gap has persisted despite the flashing dollar signs. The two biggest would-be opportunities on the table fall prey to that resistance. It’s a longer story told on a separate page, but the revenue opportunities posed by RPM and CCM/APCM are largely illusory. They’re not on the figure 1 for that reason (which is helpful because if they were, their enormous if unrealistic size would distort the scale enough to render the graph mostly useless).

GLP-1 weight management is a special case: Medicare-covered only July 2026–Dec 2027 and as yet unmeasured

Weight management is an attractive option on the table but GLP-1 is a special case for multiple reasons. Medicare began covering GLP-1 for weight reduction on July 1, 2026 as a demonstration program slated to end only 18 months later, on December 31, 2027. CMS further stated that the permanent program will not launch in Part D during that timeframe. Nevertheless, the three year revenue shown in Table 1 starts with the roughly one third of Medicare patients who appear to qualify, and includes six management visits in the first year for each such patient. It then accounts for expected attrition by counting four visits a year from an estimated 40% of patients still taking the drug in the second year and 30% in the third (see table 1, n.8 for citations). Utilization data are not available for a program so new, so the eligible share, the visit count and the persistence are estimates, and where choices were necessary, they favor GLP-1 to keep comparison with allergy testing conservative. For these reasons, GLP-1 is not included in Figure 1.

The largest realistic and well established opportunity is allergy, with AWV as an amplifier

With RPM and CCM relegated to the “unrealistic” pile, and GLP-1 by question marks, the two top candidates for revenue enhancement without substantial investment, or for reimbursable as opposed to cash pay services, are allergy testing and more annual wellness visits. The latter is the larger, on the face of it.

Further scrutiny reveals that AWV is also resistant to capture. Quite resistant, actually. There have been unique codes for it since 2011, namely G0438 for the first annual wellness visit under the program and G0439 for subsequent visits, so that they can be tracked accordingly. It turns out that’s important. CMS promoted it, as did the American Academy of Family Physicians, with radio and television advertising, and an online campaign, while the US Dept. of Health and Human Services distributed posters and other marketing collateral across the country. Since 2011 annual wellness visits have been free for patients, meaning no co-insurance, and yet uptake reached 37.3% in 2019 and stood at 38.1% in 2024, a little over a third of those eligible (see table 1, chart 10).

A graphical view of (non)uptake of AWV is persuasive.

Further details on AWV are included with the discussion of RPM & CCM. It suffices for present purposes to observe that the real AWV opportunity, to the extent it exists, inheres in capturing new annual wellness visits from the clinic’s existing patients, and that, when measured, new AWV first declined substantially, then went flat. As a revenue enhancement opportunity, therefore, AWV is nowhere near as large as the raw numbers suggest.

That leaves allergy on top for reimbursable services, but if a clinic could close and capitalize on that AWV gap, to any degree, the effort would only increase the size of the allergy testing opportunity. Allergy screening is best done upon patient intake and annually because allergies change over time. So the more annual wellness visits a clinic does, the more allergy testing candidates it will discover.

No Gap Services Not as Large as Listed but Worth Doing Strategically

The red band services—the ones where uptake and demand are roughly equal—probably deserve a closer look by any clinic looking to increase revenue without huge investments and using only existing staff. First it must be understood that small as they are, compared to the top revenue options, they’re probably overstated because the figures in Table 1 and Figure 1 both assume 100% recovery of demand. That’s not realistic in any scenario, but it’s how they’re depicted it Figure 1. That said, some of the investments required are small enough to be manageable for some clinics, and referral out is bad marketing strategy in any event. Clinic owners and business managers would be wise to consider adding these services, perhaps financed by the revenues generated by allergy testing.

3 Year Net Revenues for Cash-Based Medical Services Entail Big Risks

Cash-based (uncovered, non-reimbursable) services like medical aesthetics, off label weight management and some forms of hormone replacement, are not supported by the same big, reliable Medicare dataset as the reimbursible services in Table 1. Instead, Table 2 reflects how many times over three years each such service would need to be rendered over three years at market rates in order to generate the same net revenue as allergy testing does. To achieve that revenue level, however, investment in both equipment and marketing will be needed because all of these patients are assumed to be effectively new to the practice. As with the other services requiring investment, the investment is shown on the Z axis and reflects level of risk associated with that service addition choice. As with the “least expensive way in” rule applied to equipment needed for reimbursable services, for conservatism in the estimates, the marketing budgets for cash services are assumed to be modest. As becomes obvious from a top down view of Figure 1 (you can change the view with the mouse or gestures), the takeaway is that not only are substantial amounts of cash needed to achieve the same level of revue as allergy, the returns are considerably less certain.