1003846650

1003846650 was paid $619K by Medicaid between Jan 2018 and Dec 2022, across 5 billing codes. Its largest line is J3315, Injection, triptorelin pamoate, 3.75 mg — 82% of everything it billed.

33Billing provider info1003846650

33aNPI1003846650

33bProvider type—

28Total paid$619K

24GClaims4,648

24DCodes billed5

24AFirst – last monthJan 2018 – Dec 2022

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	1,464	$90K
2019	1,492	$208K
2020	773	$166K
2021	610	$114K
2022	309	$40K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
J3315	Injection, triptorelin pamoate, 3.75 mg	82%	789	735	$506K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	11%	2,594	2,356	$65K
96402		4.3%	854	797	$27K
99245		2.5%	352	333	$15K
99204	Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	<1%	59	59	$5K

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.