| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
Emergency department visit for the evaluation and management, high severity |
9,738 |
9,095 |
$1.54M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
13,185 |
12,663 |
$739K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
4,226 |
4,144 |
$398K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
4,705 |
4,620 |
$214K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
1,151 |
1,094 |
$118K |
| 80053 |
Comprehensive metabolic panel |
9,039 |
8,006 |
$109K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
6,595 |
6,420 |
$108K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
2,453 |
2,402 |
$77K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
10,899 |
9,483 |
$72K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
1,258 |
1,196 |
$66K |
| 87634 |
|
789 |
775 |
$65K |
| 71045 |
Radiologic examination, chest; single view |
2,301 |
2,199 |
$56K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
1,078 |
1,032 |
$54K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
1,742 |
1,571 |
$29K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
614 |
597 |
$28K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
1,062 |
1,030 |
$18K |
| 70450 |
Computed tomography, head or brain; without contrast material |
371 |
356 |
$14K |
| 93976 |
|
256 |
230 |
$13K |
| 81001 |
|
4,166 |
3,899 |
$11K |
| CP007 |
|
200 |
162 |
$9K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
194 |
181 |
$8K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
1,268 |
1,208 |
$8K |
| 83690 |
|
1,556 |
1,442 |
$6K |
| 76801 |
|
81 |
67 |
$6K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
2,310 |
1,912 |
$5K |
| 84484 |
|
1,176 |
931 |
$5K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
80 |
77 |
$5K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
797 |
703 |
$5K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
54 |
52 |
$4K |
| 81025 |
|
570 |
558 |
$4K |
| S3620 |
Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total) |
1,430 |
1,413 |
$4K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
1,220 |
1,128 |
$4K |
| 84703 |
|
653 |
615 |
$4K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
120 |
118 |
$3K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,027 |
783 |
$3K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
484 |
408 |
$3K |
| 71046 |
Radiologic examination, chest; 2 views |
69 |
66 |
$2K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
320 |
305 |
$2K |
| 84443 |
Thyroid stimulating hormone (TSH) |
518 |
497 |
$2K |
| 84702 |
|
180 |
145 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
418 |
323 |
$2K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
53 |
50 |
$1K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
92 |
84 |
$1K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
12 |
12 |
$1K |
| 83880 |
|
55 |
54 |
$893.28 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
194 |
194 |
$831.64 |
| 83735 |
|
360 |
262 |
$826.26 |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
14 |
13 |
$825.32 |
| 85610 |
|
567 |
525 |
$775.52 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
194 |
194 |
$696.97 |
| 81003 |
|
438 |
423 |
$649.64 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,128 |
1,002 |
$596.56 |
| 85730 |
|
190 |
183 |
$482.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
43 |
38 |
$403.51 |
| J0131 |
Injection, acetaminophen, not otherwise specified,10 mg |
285 |
263 |
$348.46 |
| 87186 |
|
208 |
200 |
$329.77 |
| 86900 |
|
174 |
147 |
$311.32 |
| 86901 |
|
163 |
147 |
$305.68 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
461 |
427 |
$251.50 |
| 84439 |
|
242 |
233 |
$242.56 |
| 83605 |
|
30 |
24 |
$212.91 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
206 |
201 |
$186.72 |
| 82140 |
|
30 |
27 |
$123.04 |
| 82247 |
|
12 |
12 |
$92.84 |
| Q0162 |
Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen |
62 |
60 |
$62.98 |
| 85379 |
|
12 |
12 |
$62.89 |
| 80164 |
|
16 |
14 |
$56.85 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
252 |
202 |
$49.50 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
89 |
78 |
$35.65 |
| 87077 |
|
41 |
38 |
$27.16 |
| 36415 |
Collection of venous blood by venipuncture |
1,900 |
1,741 |
$19.04 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
26 |
25 |
$1.17 |
| A9270 |
Non-covered item or service |
3,107 |
2,839 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
127 |
123 |
$0.00 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
28 |
27 |
$0.00 |