CLEANSLATE MEDICAL GROUP OF INDIANA LLC
NPI: 1023464294
· ALEXANDRIA, IN 46001
· 207R00000X
$79.21M
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
71,161 |
$298K |
| 2019 |
175,262 |
$4.99M |
| 2020 |
230,411 |
$10.42M |
| 2021 |
244,175 |
$15.73M |
| 2022 |
239,543 |
$18.09M |
| 2023 |
236,449 |
$17.18M |
| 2024 |
188,908 |
$12.51M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
497,524 |
291,542 |
$36.20M |
| 80307 |
|
428,309 |
253,335 |
$22.06M |
| 99213 |
|
272,533 |
182,358 |
$14.04M |
| G0480 |
Drug test def 1-7 classes |
87,560 |
70,218 |
$4.23M |
| T1015 |
Clinic service |
9,213 |
7,400 |
$1.10M |
| 90832 |
|
12,788 |
9,526 |
$598K |
| Q3014 |
Telehealth facility fee |
12,608 |
8,653 |
$193K |
| 90791 |
|
1,482 |
1,359 |
$147K |
| 81025 |
|
33,005 |
23,443 |
$147K |
| 99212 |
|
6,369 |
4,293 |
$145K |
| 99203 |
|
2,165 |
1,467 |
$70K |
| 90834 |
|
944 |
812 |
$59K |
| 87389 |
|
3,068 |
2,498 |
$50K |
| 99204 |
|
803 |
709 |
$47K |
| 86803 |
|
3,551 |
2,901 |
$36K |
| 99406 |
|
4,976 |
3,340 |
$30K |
| 87340 |
|
3,535 |
2,898 |
$25K |
| 99484 |
|
1,280 |
788 |
$18K |
| 99202 |
|
241 |
204 |
$7K |
| 99215 |
Prolong outpt/office vis |
50 |
41 |
$4K |
| 80076 |
|
1,130 |
686 |
$3K |
| 90833 |
|
38 |
30 |
$2K |
| 90837 |
|
19 |
13 |
$1K |
| G2012 |
Brief check in by md/qhp |
405 |
262 |
$1K |
| T1016 |
Case management |
2,246 |
1,070 |
$838.92 |
| 90853 |
|
26 |
25 |
$446.94 |
| 86704 |
|
14 |
12 |
$168.70 |
| 86706 |
|
12 |
12 |
$129.66 |
| 36415 |
|
15 |
15 |
$45.00 |