| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
34,881 |
18,244 |
$2.70M |
| A0425 |
Ground mileage, per statute mile |
44,937 |
27,096 |
$1.10M |
| A0130 |
Non-emergency transportation: wheelchair van |
30,565 |
7,567 |
$892K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
3,824 |
3,687 |
$594K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
3,893 |
3,686 |
$431K |
| S0215 |
Non-emergency transportation; mileage, per mile |
29,568 |
7,245 |
$430K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
1,384 |
1,326 |
$176K |
| A0434 |
Specialty care transport (sct) |
206 |
198 |
$83K |
| M0244 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
283 |
263 |
$49K |
| M0223 |
Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency |
46 |
46 |
$19K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
49 |
49 |
$13K |
| M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
34 |
34 |
$11K |
| 0124A |
|
473 |
472 |
$9K |
| M0246 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider based to the hospital during the covid 19 public health emergency |
15 |
15 |
$8K |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
697 |
695 |
$8K |
| M0243 |
Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring |
30 |
27 |
$8K |
| 90480 |
|
154 |
153 |
$3K |
| 0054A |
|
163 |
162 |
$2K |
| 0134A |
|
69 |
69 |
$2K |
| 99401 |
|
276 |
276 |
$714.36 |
| 0012A |
|
17 |
17 |
$129.89 |
| 0011A |
|
14 |
13 |
$126.13 |
| Q0244 |
Injection, casirivimab and imdevimab, 1200 mg |
165 |
159 |
$0.29 |
| 91312 |
|
257 |
257 |
$0.27 |
| Q0247 |
Injection, sotrovimab, 500 mg |
34 |
34 |
$0.18 |
| 91305 |
|
163 |
162 |
$0.02 |
| 90686 |
|
41 |
38 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
40 |
40 |
$0.00 |
| 91322 |
|
22 |
22 |
$0.00 |
| 91320 |
|
23 |
23 |
$0.00 |
| 91313 |
|
12 |
12 |
$0.00 |