GOMEZ, DENISE

$1K

Total Medicaid Paid

Total Claims

Beneficiaries

Codes Billed

2018-08

First Month

2018-11

Last Month

Year	Claims	Total Paid
2018	76	$1K

Code	Description	Claims	Beneficiaries	Total Paid
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit	26	25	$842.16
90688		13	13	$165.00
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	37	35	$23.76

Medicaid Provider Spending