ST. MARY'S HOSPITAL OF SUPERIOR

$1.65M

Total Medicaid Paid

54,090

Total Claims

46,026

Beneficiaries

49

Codes Billed

2018-01

First Month

2024-12

Last Month

Code	Description	Claims	Beneficiaries	Total Paid
99214		21,019	17,840	$973K
99213		13,695	12,321	$436K
90834		1,982	1,088	$73K
99283		1,333	1,266	$31K
99309		1,820	1,518	$26K
99215	Prolong outpt/office vis	279	229	$17K
90686		1,268	1,096	$14K
99605		210	205	$11K
99310	Prolong nursin fac eval 15m	453	396	$10K
99284		244	234	$8K
99308		394	258	$6K
99212		246	221	$5K
96130		48	37	$4K
99607		37	37	$3K
92015		448	398	$3K
0002A		93	90	$3K
92004		99	87	$3K
0012A		110	95	$3K
0001A		85	82	$3K
0072A		100	68	$3K
U0003	Cov-19 amp prb hgh thruput	58	55	$2K
36415		8,174	6,814	$2K
0011A		90	81	$2K
0071A		86	54	$2K
99203		27	26	$2K
20610		21	13	$1K
90791		14	13	$1K
Q3014	Telehealth facility fee	94	70	$1K
99282		51	50	$1K
90656		28	24	$596.31
99202		13	13	$532.34
0064A		20	13	$498.36
92014		13	12	$488.61
0241U		14	14	$471.87
99356		13	12	$380.10
99443		21	12	$352.20
92551		30	27	$298.92
99307		67	55	$280.35
J3301	Triamcinolone acet inj nos	68	53	$279.24
96127		62	51	$215.65
87880		13	13	$146.88
99305		15	14	$73.78
99497		12	12	$69.84
U0005	Infec agen detec ampli probe	25	25	$0.00
91301		257	224	$0.00
91307		165	109	$0.00
0352U		15	14	$0.00
G2211	Complex e/m visit add on	424	373	$0.00
91300		237	214	$0.00

Medicaid Provider Spending