| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
606 |
471 |
$454K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
7,845 |
6,540 |
$390K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
7,335 |
6,292 |
$256K |
| A0425 |
Ground mileage, per statute mile |
979 |
711 |
$255K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
950 |
737 |
$114K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
563 |
382 |
$102K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
777 |
605 |
$89K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,158 |
996 |
$87K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
3,452 |
2,469 |
$64K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
1,436 |
1,194 |
$62K |
| 36415 |
Collection of venous blood by venipuncture |
4,402 |
3,553 |
$59K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
837 |
321 |
$56K |
| 80053 |
Comprehensive metabolic panel |
532 |
448 |
$26K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
248 |
101 |
$22K |
| 90837 |
Psychotherapy, 53 minutes with patient |
495 |
170 |
$18K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
473 |
335 |
$12K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
758 |
197 |
$11K |
| 0241U |
Neonatal screening for hereditary disorders, genomic sequence analysis panel |
71 |
68 |
$10K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
174 |
157 |
$9K |
| 96127 |
|
311 |
271 |
$8K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
150 |
128 |
$7K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
24 |
12 |
$7K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
536 |
503 |
$7K |
| S0209 |
Wheelchair van, mileage, per mile |
77 |
24 |
$5K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
98 |
79 |
$4K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
67 |
21 |
$4K |
| 11721 |
|
340 |
151 |
$3K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
52 |
26 |
$3K |
| J3490 |
Unclassified drugs |
146 |
79 |
$2K |
| 84443 |
Thyroid stimulating hormone (TSH) |
57 |
56 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
69 |
51 |
$2K |
| Q2038 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone) |
15 |
14 |
$2K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
33 |
27 |
$2K |
| 80061 |
Lipid panel |
39 |
39 |
$2K |
| 90686 |
|
252 |
238 |
$1K |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
273 |
234 |
$1K |
| G0008 |
Administration of influenza virus vaccine |
69 |
67 |
$1K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
34 |
26 |
$1K |
| A0130 |
Non-emergency transportation: wheelchair van |
77 |
24 |
$1K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
13 |
12 |
$1K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
28 |
12 |
$995.90 |
| 90662 |
|
30 |
26 |
$910.44 |
| 81001 |
|
27 |
25 |
$742.78 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
69 |
63 |
$672.31 |
| A9270 |
Non-covered item or service |
545 |
239 |
$665.81 |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
14 |
14 |
$445.18 |
| 92551 |
|
66 |
65 |
$391.26 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
66 |
60 |
$389.23 |
| 85018 |
|
13 |
12 |
$240.58 |
| 99173 |
|
69 |
68 |
$200.22 |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
148 |
82 |
$184.79 |
| 90656 |
|
16 |
16 |
$84.35 |
| G2211 |
Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) |
12 |
12 |
$17.65 |
| 90651 |
|
17 |
15 |
$0.00 |
| 99188 |
|
14 |
14 |
$0.00 |