Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › MN › MINNEAPOLIS › GROUP HEALTH PLAN, INC.

GROUP HEALTH PLAN, INC.

NPI: 1710924683 · MINNEAPOLIS, MN 55407 · Urgent Care Clinic/Center · NPI assigned 06/01/2006

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official BJORKMAN, LISA controls 18+ related entities in our dataset. Read more

$204.32M
Total Medicaid Paid
6,118,276
Total Claims
5,310,546
Beneficiaries
660
Codes Billed
2018-01
First Month
2024-12
Last Month

Provider Details

Authorized OfficialBJORKMAN, LISA (DIRECTOR)
NPI Enumeration Date06/01/2006

Related Entities

Other providers sharing the same authorized official: BJORKMAN, LISA

ProviderCityStateTotal Paid
GROUP HEALTH PLAN INC. MINNEAPOLIS MN $14.79M
GROUP HEALTH PLAN INC ANDOVER MN $12.93M
GROUP HEALTH PLAN INC. EDEN PRAIRIE MN $11.52M
GROUP HEALTH PLAN INC SAINT PAUL MN $5.57M
GROUP HEALTH PLAN, INC STILLWATER MN $3.65M
GROUP HEALTH PLAN INC SAINT PAUL MN $3.61M
GROUP HEALTH PLAN INC SAINT PAUL MN $1.16M
PHYSICIANS NECK & BACK CLINICS ROSEVILLE MN $859K
GROUP HEALTH PLAN INC MINNEAPOLIS MN $828K
GROUP HEALTH PLAN, INC. SAINT PAUL MN $779K
GROUP HEALTH PLAN INC BLOOMINGTON MN $594K
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC STILLWATER MN $159K
GROUP HEALTH PLAN, INC. ANOKA MN $84K
GROUP HEALTH PLAN INC SOMERSET WI $80K
GROUP HEALTH PLAN INC HUDSON WI $53K
GROUP HEALTH PLAN, INC STILLWATER MN $50K
GROUP HEALTH PLAN, INC MAPLEWOOD MN $17K
GROUP HEALTH PLAN INC SAINT PAUL MN $1K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 1,141,676 $10.64M
2019 1,103,687 $40.04M
2020 914,447 $35.39M
2021 1,180,294 $47.57M
2022 870,373 $33.96M
2023 494,917 $19.79M
2024 412,882 $16.93M

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
99214 Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity 437,342 381,115 $28.79M
99213 Office or other outpatient visit for the evaluation and management of an established patient, low complexity 497,277 448,478 $23.57M
99233 Prolong inpt eval add15 m 273,373 55,968 $14.41M
99223 Prolong inpt eval add15 m 65,556 42,065 $6.32M
99215 Prolong outpt/office vis 57,814 51,535 $4.97M
S0302 Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) 155,974 152,904 $4.63M
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 51,256 48,637 $4.44M
99203 Office or other outpatient visit for the evaluation and management of a new patient, low complexity 69,274 65,973 $4.41M
99204 Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity 40,964 38,480 $3.74M
59400 Routine obstetric care including antepartum care, vaginal delivery, and postpartum care 3,696 3,436 $3.53M
99291 Critical care, evaluation and management of the critically ill patient, first 30-74 minutes 29,467 8,521 $3.17M
99392 Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) 46,775 45,295 $3.08M
92014 Ophthalmological services: medical examination and evaluation, comprehensive, established patient 39,026 38,205 $3.02M
99232 Subsequent hospital care, per day, moderate complexity 87,406 26,446 $2.88M
99310 Prolong nursin fac eval 15m 46,454 27,623 $2.81M
90460 Immunization administration through 18 years of age via any route, first or only component 102,530 100,240 $2.81M
92004 Ophthalmological services: medical examination and evaluation, comprehensive, new patient 29,378 28,797 $2.68M
T1013 Sign language or oral interpretive services, per 15 minutes 82,388 69,038 $2.42M
99393 Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) 37,410 35,749 $2.40M
88305 Level IV - Surgical pathology, gross and microscopic examination 34,557 32,773 $2.37M
99391 Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) 40,542 38,249 $2.32M
X5622 69,452 60,903 $2.31M
99239 Hospital discharge day management, more than 30 minutes 38,473 34,317 $2.10M
99202 Office or other outpatient visit for the evaluation and management of a new patient, straightforward 39,748 37,919 $1.52M
59510 1,476 1,341 $1.47M
99394 Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) 21,048 20,092 $1.46M
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine 108,283 105,061 $1.42M
36415 Collection of venous blood by venipuncture 378,692 339,115 $1.27M
99396 Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years 14,935 14,302 $1.22M
99395 Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years 16,568 15,932 $1.21M
87651 Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe 35,149 34,342 $1.19M
V2020 Frames, purchases 37,299 36,353 $1.18M
99222 Initial hospital care, per day, moderate complexity 19,245 14,836 $1.13M
U0005 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, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 40,624 38,475 $1.10M
99205 Prolong outpt/office vis 10,218 9,512 $1.08M
87491 Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe 33,670 32,519 $1.06M
87591 Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe 33,134 31,992 $1.05M
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies 1,346 1,312 $1.04M
99212 Office or other outpatient visit for the evaluation and management of an established patient, straightforward 33,639 31,917 $950K
99309 Subsequent nursing facility care, per day, low to moderate complexity 23,822 18,130 $949K
76816 Ultrasound, pregnant uterus, real time with image documentation, follow-up 12,292 10,881 $874K
92015 Determination of refractive state 70,049 68,730 $853K
93306 Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete 19,345 18,151 $826K
99211 Office or other outpatient visit for the evaluation and management of an established patient, minimal severity 50,688 47,040 $791K
J0178 Injection, aflibercept, 1 mg 369 359 $723K
99385 8,650 8,255 $678K
90961 5,466 5,082 $659K
J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg 857 827 $651K
99220 7,237 6,539 $649K
77067 Screening mammography, bilateral, including computer-aided detection 8,975 8,746 $638K
92340 Fitting of spectacles, except for aphakia; monofocal 27,114 26,453 $632K
90750 5,928 5,737 $630K
83036 Hemoglobin; glycosylated (A1C) 68,691 67,753 $629K
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 9,262 8,845 $623K
92551 97,694 95,685 $616K
84443 Thyroid stimulating hormone (TSH) 40,568 39,907 $612K
99188 73,278 72,017 $606K
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only 134,894 105,761 $559K
99336 10,111 7,940 $544K
J0585 Injection, onabotulinumtoxina, 1 unit 943 551 $517K
87389 Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies 23,405 23,127 $513K
90834 Psychotherapy, 45 minutes with patient 11,318 7,786 $475K
V2103 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens 30,661 17,229 $474K
90651 17,243 16,919 $467K
90686 77,839 76,614 $465K
J1050 Injection, medroxyprogesterone acetate, 1 mg 6,432 6,315 $464K
76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation 5,039 4,897 $441K
76818 5,291 2,730 $422K
80061 Lipid panel 33,235 32,901 $418K
G0108 Diabetes outpatient self-management training services, individual, per 30 minutes 7,261 6,557 $417K
76830 Ultrasound, transvaginal 5,618 5,452 $409K
96127 111,263 109,434 $408K
87480 21,447 20,664 $406K
87510 21,407 20,629 $405K
90732 4,692 4,495 $405K
87660 21,396 20,610 $405K
76819 Fetal biophysical profile; without non-stress testing 7,936 4,205 $397K
88307 3,671 3,428 $393K
90837 Psychotherapy, 53 minutes with patient 5,324 3,594 $391K
86481 3,617 3,558 $387K
96110 Developmental screening, with scoring and documentation, per standardized instrument 62,137 54,328 $381K
80307 Drug test(s), presumptive, any number of drug classes; immunoassay 7,711 6,572 $380K
99384 4,794 4,507 $370K
76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 5,415 5,286 $368K
90715 21,525 21,110 $364K
99383 5,472 5,121 $356K
90472 Immunization administration, each additional vaccine (list separately) 23,524 22,992 $349K
76801 4,452 4,286 $345K
90691 3,762 3,652 $343K
76811 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed 2,717 2,670 $336K
87624 Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types 10,082 9,958 $321K
99460 5,813 5,548 $320K
85025 Blood count; complete (CBC), automated, and automated differential WBC count 49,157 46,320 $317K
0001A 8,173 8,128 $308K
85027 53,337 52,072 $291K
80048 Basic metabolic panel (calcium, ionized) 38,863 37,384 $291K
97802 5,253 5,177 $284K
87507 660 658 $280K
91320 2,504 2,493 $278K
V5261 Hearing aid, digital, binaural, bte 157 149 $276K
99238 Hospital discharge day management, 30 minutes or less 6,558 6,210 $275K
G0179 Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care 14,599 13,865 $270K
71046 Radiologic examination, chest; 2 views 15,627 14,676 $264K
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis 619 504 $263K
99386 2,913 2,753 $263K
0002A 6,715 6,682 $261K
90746 4,742 4,624 $256K
90962 3,434 3,205 $255K
99231 Subsequent hospital care, per day, straightforward or low complexity 14,635 6,523 $254K
93793 33,821 16,315 $247K
86780 19,702 19,345 $241K
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed 12,188 11,995 $240K
17110 3,885 3,562 $234K
67028 Intravitreal injection of a pharmacologic agent 2,702 2,605 $234K
99381 4,303 4,139 $232K
91322 1,780 1,770 $227K
90677 1,990 1,972 $220K
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) 1,450 1,397 $215K
99217 5,846 5,341 $212K
82728 16,617 16,280 $210K
59025 Fetal non-stress test 11,199 6,360 $210K
76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal 3,460 2,872 $203K
99337 1,571 1,314 $199K
96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 24,223 19,573 $197K
92012 Ophthalmological services: medical examination and evaluation, intermediate, established patient 4,076 3,799 $196K
90480 6,091 5,886 $196K
88342 3,339 2,705 $192K
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 4,341 3,959 $192K
V2203 Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens 8,599 4,714 $190K
G0480 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed 2,827 2,523 $186K
92060 4,546 4,394 $180K
G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision 8,233 8,003 $172K
92341 6,313 6,043 $171K
76825 897 844 $168K
99349 2,268 2,053 $167K
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour 3,979 3,068 $166K
80053 Comprehensive metabolic panel 14,982 14,298 $166K
99397 1,667 1,511 $161K
0004A 4,884 4,286 $154K
86803 11,757 11,645 $154K
80050 General health panel 2,958 2,815 $152K
92134 5,493 5,208 $151K
99306 Prolong nursin fac eval 15m 1,627 1,394 $150K
90791 Psychiatric diagnostic evaluation 1,631 1,571 $149K
81025 20,347 19,627 $147K
99382 2,428 2,267 $144K
83655 12,825 12,711 $142K
90717 1,254 1,194 $137K
86003 24,790 2,231 $136K
83970 3,440 3,372 $136K
90670 28,873 28,418 $133K
45380 Colonoscopy, flexible; with biopsy, single or multiple 1,798 1,720 $133K
99173 89,534 88,349 $129K
99402 3,523 3,416 $129K
J9035 Injection, bevacizumab, 10 mg 1,619 1,551 $128K
99221 2,393 2,174 $126K
93000 15,268 14,545 $125K
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 2,032 1,965 $124K
77063 Screening digital breast tomosynthesis, bilateral 3,460 3,425 $123K
97803 3,143 2,837 $122K
0071A 2,962 2,831 $120K
90792 Psychiatric diagnostic evaluation with medical services 977 948 $120K
82607 8,386 8,275 $118K
87086 Culture, bacterial; quantitative colony count, urine 15,764 15,088 $118K
84466 8,327 8,236 $116K
76815 Ultrasound, pregnant uterus, real time with image documentation, limited 2,520 2,266 $115K
73630 6,278 5,492 $112K
J7300 Intrauterine copper contraceptive (paragard) 170 166 $108K
0072A 2,570 2,522 $106K
31575 1,761 1,633 $106K
96413 Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance 1,366 1,155 $105K
76813 1,362 1,309 $105K
90734 14,039 13,739 $104K
87502 Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets 1,197 1,180 $102K
76700 Ultrasound, abdominal, real time with image documentation; complete 1,424 1,387 $102K
58300 2,105 2,024 $100K
83020 6,641 5,245 $100K
95886 1,240 1,210 $98K
87340 10,169 10,018 $95K
0064A 2,659 2,633 $95K
81001 37,276 35,213 $94K
90832 Psychotherapy, 30 minutes with patient 2,243 1,711 $93K
20610 2,591 2,137 $93K
99350 Prolong home eval add 15m 992 823 $92K
88142 6,105 5,915 $88K
82565 18,330 17,661 $87K
V2100 Sphere, single vision, plano to plus or minus 4.00, per lens 5,599 3,801 $87K
87506 515 507 $87K
G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician 3,142 3,128 $87K
84460 17,090 16,618 $84K
84403 3,386 3,299 $83K
69210 3,012 2,804 $82K
V5160 Dispensing fee, binaural 271 248 $82K
58301 1,412 1,348 $80K
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and allowed practitioners to affirm the initial implementation of the plan of care 3,091 2,949 $80K
99219 1,094 1,030 $78K
92557 3,368 3,255 $77K
76820 2,426 1,101 $76K
S0281 Medical home program, comprehensive care coordination and planning, maintenance of plan 10,177 9,642 $74K
90632 1,635 1,596 $73K
0011A 2,035 2,022 $72K
92567 7,762 7,497 $71K
82570 14,249 13,527 $70K
92083 1,685 1,609 $70K
11981 1,092 1,060 $69K
80076 10,921 10,472 $68K
G0008 Administration of influenza virus vaccine 10,271 9,699 $68K
86235 1,977 852 $67K
85018 30,773 30,000 $67K
84702 4,865 3,292 $67K
88341 682 615 $66K
73610 3,440 3,137 $66K
83540 10,690 10,541 $65K
85060 3,408 3,221 $65K
0124A 1,847 1,815 $64K
0012A 1,697 1,684 $63K
87536 881 854 $63K
99462 2,626 1,904 $63K
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) 641 614 $62K
85610 20,532 13,439 $61K
99443 4,916 4,003 $61K
95004 Percutaneous tests with allergenic extracts, immediate type reaction 1,064 1,040 $61K
0054A 1,617 1,585 $59K
84439 7,279 7,102 $59K
90674 6,619 6,535 $59K
57454 678 668 $58K
82043 10,533 10,410 $58K
90716 9,037 8,889 $57K
86706 4,648 4,594 $55K
84450 11,571 11,070 $55K
87088 7,279 7,090 $54K
84270 2,634 2,548 $54K
90739 339 335 $54K
86762 3,928 3,882 $54K
90694 3,750 3,584 $53K
31231 464 423 $53K
G0103 Prostate cancer screening; prostate specific antigen test (psa) 2,819 2,801 $52K
Q5103 Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg 28 26 $52K
G0328 Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous 3,218 3,195 $52K
82248 9,741 9,220 $52K
87517 1,245 1,226 $51K
36416 17,092 16,355 $51K
87529 1,128 1,045 $48K
82274 2,849 2,838 $48K
0134A 1,355 1,330 $48K
87077 6,070 5,590 $47K
92133 1,958 1,880 $47K
90461 11,704 10,920 $46K
87070 5,978 5,800 $46K
87635 Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe 848 831 $46K
76536 626 622 $45K
86140 9,379 8,958 $45K
82105 2,864 2,787 $44K
73562 1,815 1,304 $44K
84146 2,414 2,350 $44K
J1756 Injection, iron sucrose, 1 mg 825 542 $44K
87338 3,275 3,238 $44K
V2104 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens 2,981 1,923 $44K
83516 3,899 2,793 $44K
87798 Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism 1,126 864 $41K
99226 657 429 $41K
83735 6,411 6,196 $41K
11982 625 604 $40K
97110 Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion 1,908 1,034 $40K
99316 763 692 $40K
94010 2,996 2,782 $39K
88304 1,863 1,803 $38K
86850 4,412 4,307 $38K
87186 4,770 4,422 $38K
73030 2,012 1,790 $38K
83880 986 950 $38K
81003 20,903 20,419 $38K
87661 Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe 1,034 983 $37K
73564 1,418 1,375 $37K
99442 4,508 3,770 $37K
83001 2,121 2,086 $37K
G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment 319 296 $36K
90675 98 55 $36K
10060 497 475 $35K
69209 3,732 3,504 $35K
90661 4,440 4,434 $34K
86480 1,504 1,470 $34K
V2107 Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens 2,097 1,285 $34K
V5266 Battery for use in hearing device 1,700 1,630 $34K
93294 1,515 1,470 $34K
85049 8,517 8,171 $34K
73502 1,245 1,203 $33K
88141 1,933 1,877 $33K
92136 968 895 $33K
72100 1,536 1,482 $33K
96161 21,297 20,511 $32K
0051A 845 832 $32K
83718 4,385 4,353 $32K
86160 2,830 1,317 $32K
78452 Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress 633 613 $32K
V5020 Conformity evaluation 445 405 $32K
90707 7,394 7,266 $31K
87209 1,592 893 $31K
84481 2,019 1,981 $30K
81220 CFTR (cystic fibrosis transmembrane conductance regulator) gene analysis; common variants 121 115 $30K
82784 2,923 2,406 $29K
V2200 Sphere, bifocal, plano to plus or minus 4.00d, per lens 1,484 1,092 $29K
99417 Prolong home eval add 15m 786 752 $29K
82947 8,172 7,915 $29K
86360 678 631 $29K
93971 487 475 $28K
84153 1,680 1,653 $28K
90653 342 341 $27K
99201 1,198 1,143 $27K
84132 6,491 6,278 $27K
82746 1,876 1,850 $26K
92587 2,143 2,077 $26K
L3908 Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf 1,449 1,271 $26K
99285 Emergency department visit for the evaluation and management, high severity with immediate threat to life 213 200 $25K
90473 1,901 1,896 $25K
88312 266 237 $25K
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) 9,022 8,668 $25K
73110 1,105 1,015 $25K
88112 657 598 $25K
83721 2,675 2,648 $25K
87522 Neg quan hep c or qual rna 719 701 $25K
90662 3,224 3,069 $25K
90714 1,676 1,619 $24K
74019 1,259 1,187 $24K
99308 Subsequent nursing facility care, per day, straightforward 743 647 $23K
G0659 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes 640 614 $23K
76821 333 127 $23K
86704 2,039 2,006 $23K
86359 673 630 $23K
87801 Infectious agent detection by nucleic acid; amplified probe, multiple organisms 310 298 $23K
73140 1,126 1,067 $23K
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction 2,759 2,434 $23K
92579 820 808 $22K
77080 2,452 1,991 $22K
95806 389 358 $21K
52000 202 192 $20K
G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) 7,965 7,362 $20K
92591 339 326 $20K
84402 750 746 $20K
99284 Emergency department visit for the evaluation and management, high severity 245 232 $20K
83690 3,156 3,083 $20K
46600 312 299 $20K
83520 1,513 1,407 $20K
82465 4,937 4,891 $19K
87636 Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B 135 126 $19K
93325 1,327 1,241 $18K
96415 701 613 $18K
92552 1,026 978 $18K
92002 460 449 $18K
82681 604 593 $18K
95117 2,993 1,469 $18K
86038 1,833 1,746 $18K
11102 245 239 $18K
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg 4,183 3,834 $18K
82950 4,113 4,042 $17K
84295 4,000 3,921 $17K
87177 2,246 1,223 $17K
82670 680 662 $17K
98941 Chiropractic manipulative treatment; spinal, 3-4 regions 1,086 618 $17K
73130 824 766 $16K
0052A 408 392 $16K
85652 6,811 6,568 $16K
86317 2,328 2,153 $16K
84207 559 551 $16K
87637 Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV 108 104 $16K
82951 1,317 1,301 $16K
82627 734 725 $15K
86618 1,002 997 $15K
84425 704 697 $15K
83002 864 854 $15K
86787 1,283 1,273 $15K
82550 2,548 2,442 $15K
82247 3,303 2,368 $15K
93976 137 136 $14K
81329 119 95 $14K
11900 511 478 $14K
A4627 Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler 982 929 $14K
86039 1,324 1,261 $14K
0082A 417 405 $14K
96160 8,128 7,800 $13K
99292 163 110 $13K
99497 324 280 $13K
20550 529 397 $13K
84550 3,169 3,061 $13K
87481 348 336 $13K
86696 669 663 $13K
99177 1,470 1,465 $12K
87210 3,820 3,628 $12K
11104 111 110 $12K
84156 3,464 3,080 $12K
86900 4,164 4,068 $12K
86901 4,129 4,042 $12K
90847 Family psychotherapy with the patient present, 50 minutes 202 155 $11K
64615 129 127 $11K
82310 2,265 2,198 $11K
93351 240 228 $11K
83013 148 146 $11K
81401 113 110 $11K
11200 226 216 $10K
86225 898 795 $10K
90713 2,279 2,243 $10K
0031A 269 268 $10K
64483 133 129 $10K
84165 1,006 981 $10K
92556 535 508 $10K
J0881 Injection, darbepoetin alfa, 1 microgram (non-esrd use) 43 26 $10K
86200 861 834 $10K
80069 1,174 1,114 $10K
86708 905 891 $10K
11750 105 83 $10K
87493 399 389 $10K
74018 549 526 $9K
72050 356 342 $9K
93227 691 666 $9K
85730 1,609 1,254 $9K
90672 8,047 7,992 $9K
86431 1,760 1,705 $9K
0154A 218 208 $9K
86769 198 194 $9K
51798 1,321 1,226 $9K
G0009 Administration of pneumococcal vaccine 1,507 1,398 $9K
84703 1,277 1,233 $8K
97140 Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) 477 215 $8K
86695 638 633 $8K
95720 69 45 $8K
87205 2,077 1,966 $8K
95012 732 690 $8K
86255 630 396 $8K
99401 439 417 $8K
86376 645 623 $7K
E0114 Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips 284 272 $7K
V2784 Lens, polycarbonate or equal, any index, per lens 1,038 522 $7K
87631 47 47 $7K
90474 788 778 $7K
87880 Infectious agent antigen detection by immunoassay; Streptococcus, group A 4,570 4,326 $7K
93016 588 564 $7K
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia 61 60 $7K
99152 1,003 906 $7K
76770 89 87 $7K
99174 2,219 2,167 $7K
86256 593 539 $7K
86336 444 428 $7K
0081A 292 273 $6K
84520 1,835 1,769 $6K
99441 1,272 1,179 $6K
93018 775 744 $6K
99403 147 147 $6K
84100 1,387 1,346 $6K
94726 828 808 $6K
64493 88 76 $6K
95251 287 283 $6K
58100 77 74 $5K
76376 663 652 $5K
93308 330 306 $5K
93295 259 241 $5K
L0621 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf 420 406 $5K
J0561 Injection, penicillin g benzathine, 100,000 units 16 12 $5K
94729 890 870 $5K
11042 Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm 74 54 $5K
82533 274 248 $5K
84704 311 298 $5K
84163 312 299 $5K
80306 458 326 $5K
11100 381 344 $4K
95811 108 101 $4K
85045 1,153 1,110 $4K
82040 920 889 $4K
94060 380 362 $4K
81513 28 28 $4K
0112A 105 103 $4K
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 835 826 $4K
87634 57 57 $4K
71101 174 165 $4K
92250 141 130 $4K
88173 52 49 $4K
0003A 253 223 $4K
43235 86 80 $4K
83525 321 318 $4K
92511 51 49 $4K
86308 891 870 $4K
84075 800 764 $4K
87206 760 679 $4K
96040 103 100 $4K
83498 127 124 $4K
82150 672 656 $4K
99607 64 64 $4K
86765 282 280 $3K
76705 Ultrasound, abdominal, real time with image documentation; limited 55 55 $3K
73660 166 157 $3K
99451 141 139 $3K
17000 103 101 $3K
99404 43 43 $3K
86592 758 745 $3K
99356 87 70 $3K
93352 136 131 $3K
V2105 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens 187 130 $3K
99605 55 55 $3K
83993 156 156 $3K
0111A 76 76 $3K
0083A 73 73 $3K
84144 163 159 $3K
86147 76 65 $3K
82397 203 202 $3K
99421 354 337 $3K
G0472 Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 67 65 $3K
86735 218 215 $3K
0074A 269 269 $3K
84155 762 738 $3K
72040 173 159 $3K
73560 112 99 $3K
J3420 Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1,891 1,560 $3K
95909 38 37 $3K
58340 13 13 $3K
11983 24 24 $3K
99335 213 173 $3K
87081 2,603 2,478 $2K
87101 361 352 $2K
0144A 59 59 $2K
82785 123 122 $2K
90785 215 182 $2K
73590 179 163 $2K
90935 Hemodialysis procedure with single evaluation by a physician 55 25 $2K
87563 57 56 $2K
L4360 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise 46 43 $2K
92523 13 13 $2K
92593 55 50 $2K
85379 183 182 $2K
J0696 Injection, ceftriaxone sodium, per 250 mg 1,727 1,478 $2K
90710 6,117 5,981 $2K
86682 159 118 $2K
87220 555 540 $2K
76377 53 52 $2K
92553 149 138 $2K
87505 12 12 $2K
92020 92 92 $2K
93272 102 101 $2K
82962 1,224 1,091 $2K
87184 204 196 $2K
17250 39 38 $2K
99406 138 131 $1K
84112 30 29 $1K
96375 Therapeutic injection; each additional sequential IV push 110 98 $1K
80164 111 107 $1K
97161 25 25 $1K
90744 1,693 1,671 $1K
U0002 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc 28 28 $1K
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour 133 97 $1K
L4350 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf 43 40 $1K
64494 26 24 $1K
73523 39 39 $1K
G2012 Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 436 401 $1K
80074 25 25 $1K
98940 220 134 $1K
J2790 Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) 14 14 $1K
L2999 Lower extremity orthoses, not otherwise specified 208 194 $1K
76514 154 151 $1K
92285 76 74 $1K
80051 151 150 $1K
92550 67 67 $1K
J1040 Injection, methylprednisolone acetate, 80 mg 153 146 $1K
76831 13 13 $1K
82977 193 192 $1K
92555 100 95 $1K
86665 49 25 $1K
82952 386 377 $1K
84134 56 53 $973.32
76870 12 12 $948.42
J1885 Injection, ketorolac tromethamine, per 15 mg 918 695 $942.38
72110 40 37 $938.19
12001 14 14 $922.92
93280 42 37 $863.52
92583 24 24 $845.23
91200 136 134 $828.95
27096 15 12 $803.87
90723 22,596 22,292 $777.50
51702 16 12 $774.62
0034A 42 25 $765.00
90647 21,863 21,545 $750.20
V2108 Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens 35 25 $729.54
95810 Polysomnography; sleep staging with 4 or more additional parameters 12 12 $711.22
20553 27 25 $690.44
73070 49 43 $686.72
72072 26 26 $684.87
90680 17,312 17,081 $661.34
A6448 Light compression bandage, elastic, knitted/woven, width less than three inches, per yard 652 626 $658.93
82435 133 125 $655.56
73090 28 27 $649.01
92582 13 13 $648.48
93321 151 142 $603.21
L3260 Surgical boot/shoe, each 101 96 $597.62
82610 38 37 $596.40
84445 12 12 $594.77
85670 91 90 $575.30
V2204 Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens 36 25 $558.15
92504 25 25 $526.72
76519 13 13 $518.53
96381 33 33 $515.25
87147 311 282 $509.66
92082 14 13 $491.22
98968 44 40 $481.33
84630 40 39 $473.68
36620 13 12 $472.64
86664 25 25 $424.12
99606 13 12 $407.40
96374 Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance 14 13 $404.16
80178 76 72 $403.98
80177 27 27 $393.42
97535 Self-care/home management training, each 15 minutes 21 13 $376.33
V2101 Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens 19 13 $366.70
86663 25 25 $363.86
82677 12 12 $360.48
73552 12 12 $347.76
95816 17 13 $332.11
85048 151 149 $330.80
73080 14 13 $322.60
99498 13 12 $319.57
90660 591 591 $301.21
83615 78 76 $279.51
90633 18,051 17,758 $274.05
92025 12 12 $264.64
86364 13 12 $258.66
86709 43 41 $248.64
A4570 Splint 64 63 $230.26
70355 26 25 $221.90
86141 12 12 $213.00
A4565 Slings 74 68 $212.71
88302 12 12 $205.55
84480 12 12 $188.30
84478 28 26 $179.20
93790 12 12 $168.74
85660 24 24 $155.76
J7613 Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg 1,569 1,477 $155.08
87107 13 13 $154.08
86707 12 12 $148.96
87350 12 12 $146.66
86580 46 39 $142.26
90696 6,593 6,441 $119.26
45381 12 12 $108.70
82340 13 12 $80.36
J7620 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme 647 620 $58.04
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable 15 15 $44.70
G0010 Administration of hepatitis b vaccine 25 24 $37.33
J1100 Injection, dexamethasone sodium phosphate, 1 mg 19 16 $22.02
90700 6,424 6,332 $18.73
J1071 Injection, testosterone cypionate, 1 mg 104 63 $3.00
91319 329 329 $0.00
91318 160 159 $0.00
95910 13 12 $0.00
57455 13 12 $0.00
88738 34 29 $0.00
90381 29 29 $0.00
S0280 Medical home program, comprehensive care coordination and planning, initial plan 27 27 $0.00
99444 28 26 $0.00
91300 59 57 $0.00
90685 925 872 $0.00
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory 165 160 $0.00
91321 186 186 $0.00
99307 24 12 $0.00
G1004 Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program 13 13 $0.00
J1745 Injection, infliximab, excludes biosimilar, 10 mg 17 12 $0.00