| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
1,943 |
1,245 |
$197K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,122 |
13,301 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
4,780 |
4,359 |
$8K |
| 99215 |
Prolong outpt/office vis |
400 |
383 |
$799.68 |
| 99239 |
Hospital discharge day management, more than 30 minutes |
116 |
106 |
$477.36 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
908 |
863 |
$404.96 |
| 82962 |
|
4,381 |
3,647 |
$295.59 |
| 99205 |
Prolong outpt/office vis |
228 |
228 |
$287.64 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
670 |
642 |
$184.96 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
55 |
55 |
$152.32 |
| 81025 |
|
3,806 |
3,446 |
$118.32 |
| 99442 |
|
1,511 |
1,321 |
$67.60 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
66 |
61 |
$12.24 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
860 |
737 |
$11.57 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
430 |
356 |
$3.87 |
| 81001 |
|
7,334 |
6,501 |
$0.00 |
| 99443 |
|
170 |
156 |
$0.00 |
| G9003 |
Coordinated care fee, risk adjusted high, initial |
737 |
466 |
$0.00 |
| G9005 |
Coordinated care fee, risk adjusted maintenance |
565 |
286 |
$0.00 |
| 99441 |
|
1,406 |
1,275 |
$0.00 |
| 99000 |
|
106 |
96 |
$0.00 |
| 99386 |
|
55 |
55 |
$0.00 |
| 3079F |
|
16 |
14 |
$0.00 |
| 1111F |
|
16 |
15 |
$0.00 |
| 3074F |
|
15 |
14 |
$0.00 |
| 99385 |
|
17 |
15 |
$0.00 |
| 99349 |
|
14 |
14 |
$0.00 |
| 90674 |
|
16 |
14 |
$0.00 |
| 99348 |
|
13 |
13 |
$0.00 |
| 99499 |
|
1,156 |
746 |
$0.00 |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
756 |
659 |
$0.00 |
| 90756 |
|
315 |
275 |
$0.00 |
| G9010 |
Coordinated care fee, risk adjusted maintenance, level 4 |
909 |
407 |
$0.00 |
| G9011 |
Coordinated care fee, risk adjusted maintenance, level 5 |
165 |
72 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
139 |
117 |
$0.00 |
| 99221 |
|
28 |
27 |
$0.00 |
| G9004 |
Coordinated care fee, risk adjusted low, initial |
241 |
120 |
$0.00 |
| T2023 |
Targeted case management; per month |
413 |
405 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
14 |
13 |
$0.00 |
| 90715 |
|
81 |
71 |
$0.00 |
| 3077F |
|
13 |
12 |
$0.00 |