JACKEL, DONALD

$5K

Total Medicaid Paid

91

Total Claims

91

Beneficiaries

4

Codes Billed

2018-01

First Month

2019-01

Last Month

Year	Claims	Total Paid
2018	79	$4K
2019	12	$929.52

Code	Description	Claims	Beneficiaries	Total Paid
99213	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	41	41	$2K
99203	Office or other outpatient visit for the evaluation and management of a new patient, low complexity	25	25	$2K
99214	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	12	12	$929.52
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	13	13	$153.53

Medicaid Provider Spending