CLEANSLATE MEDICAL GROUP OF PENNSYLVANIA LLC
NPI: 1184177263
· WILKES BARRE, PA 18702
· 207RA0401X
$18.61M
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,912 |
$5K |
| 2019 |
739 |
$2K |
| 2020 |
14,875 |
$1.09M |
| 2021 |
70,765 |
$5.37M |
| 2022 |
74,487 |
$5.14M |
| 2023 |
61,078 |
$3.97M |
| 2024 |
51,134 |
$3.04M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
163,162 |
120,325 |
$8.47M |
| G9012 |
Other specified case mgmt |
25,701 |
25,575 |
$6.83M |
| 99213 |
|
61,980 |
50,702 |
$2.10M |
| 80307 |
|
11,288 |
5,925 |
$689K |
| G0480 |
Drug test def 1-7 classes |
3,167 |
2,650 |
$198K |
| 99204 |
|
944 |
787 |
$67K |
| 99340 |
|
341 |
319 |
$48K |
| 90834 |
|
649 |
387 |
$48K |
| T2023 |
Targeted case mgmt per month |
441 |
441 |
$44K |
| G9002 |
Mccd,maintenance rate |
246 |
243 |
$36K |
| 90832 |
|
881 |
649 |
$31K |
| 81025 |
|
5,182 |
4,821 |
$19K |
| 96372 |
|
1,705 |
1,618 |
$17K |
| 99203 |
|
212 |
143 |
$5K |
| Q3014 |
Telehealth facility fee |
272 |
253 |
$4K |
| 99212 |
|
115 |
102 |
$3K |
| T1016 |
Case management |
126 |
108 |
$2K |
| 87389 |
|
24 |
24 |
$690.69 |
| 99406 |
|
65 |
53 |
$427.50 |
| H2015 |
Comp comm supp svc, 15 min |
326 |
167 |
$360.00 |
| 87340 |
|
12 |
12 |
$171.49 |
| H0038 |
Self-help/peer svc per 15min |
121 |
98 |
$9.00 |
| 99205 |
Prolong outpt/office vis |
30 |
14 |
$0.00 |