| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0425 |
Ground mileage, per statute mile |
2,217 |
1,842 |
$32K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
3,445 |
2,313 |
$30K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
1,204 |
1,057 |
$28K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
545 |
478 |
$26K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
450 |
426 |
$21K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
1,448 |
950 |
$21K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
192 |
146 |
$13K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
1,356 |
1,061 |
$12K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
683 |
635 |
$12K |
| 70450 |
Computed tomography, head or brain; without contrast material |
262 |
243 |
$12K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
266 |
234 |
$11K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
550 |
477 |
$10K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
115 |
110 |
$9K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
1,625 |
588 |
$9K |
| G0378 |
Hospital observation service, per hour |
112 |
108 |
$9K |
| 71250 |
|
108 |
105 |
$9K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
183 |
145 |
$8K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
528 |
373 |
$8K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
171 |
165 |
$7K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
118 |
101 |
$6K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
118 |
109 |
$6K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
1,134 |
1,009 |
$6K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
81 |
80 |
$6K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
596 |
549 |
$5K |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
542 |
441 |
$5K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
820 |
695 |
$5K |
| 80053 |
Comprehensive metabolic panel |
3,196 |
2,790 |
$5K |
| 71046 |
Radiologic examination, chest; 2 views |
579 |
559 |
$5K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
98 |
48 |
$5K |
| A0434 |
Specialty care transport (sct) |
82 |
81 |
$4K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
529 |
445 |
$4K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
39 |
39 |
$4K |
| 96413 |
Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial substance |
104 |
77 |
$3K |
| 73564 |
|
174 |
164 |
$3K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
103 |
102 |
$3K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
244 |
238 |
$3K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
225 |
194 |
$3K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
282 |
252 |
$3K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
3,035 |
2,609 |
$3K |
| 93017 |
|
45 |
45 |
$2K |
| 73030 |
|
164 |
145 |
$2K |
| 73502 |
|
124 |
120 |
$2K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
98 |
98 |
$2K |
| 71045 |
Radiologic examination, chest; single view |
265 |
250 |
$2K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,049 |
1,020 |
$2K |
| 76770 |
|
60 |
59 |
$2K |
| 97161 |
|
177 |
159 |
$1K |
| 73610 |
|
143 |
130 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
218 |
182 |
$1K |
| 73630 |
|
173 |
153 |
$1K |
| 70496 |
|
16 |
15 |
$1K |
| 94726 |
|
129 |
79 |
$1K |
| 76830 |
Ultrasound, transvaginal |
84 |
84 |
$1K |
| 70498 |
|
15 |
14 |
$1K |
| 97162 |
|
133 |
122 |
$1K |
| 94729 |
|
148 |
90 |
$1K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
496 |
225 |
$1K |
| 96367 |
|
31 |
28 |
$1K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
30 |
18 |
$1K |
| 76536 |
|
30 |
30 |
$1K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
406 |
394 |
$1K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
712 |
612 |
$1K |
| 76642 |
|
46 |
45 |
$980.68 |
| 84484 |
|
805 |
430 |
$977.10 |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
117 |
116 |
$935.96 |
| 73562 |
|
72 |
67 |
$930.46 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,027 |
1,012 |
$906.69 |
| 80061 |
Lipid panel |
1,022 |
999 |
$879.32 |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
22 |
14 |
$855.60 |
| 72100 |
|
64 |
62 |
$829.35 |
| 83880 |
|
143 |
135 |
$825.56 |
| 83735 |
|
887 |
732 |
$780.87 |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
190 |
116 |
$754.83 |
| 87481 |
|
384 |
186 |
$701.14 |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
12 |
12 |
$692.29 |
| 73130 |
|
115 |
97 |
$680.22 |
| 36415 |
Collection of venous blood by venipuncture |
2,347 |
1,981 |
$659.99 |
| 83970 |
|
115 |
113 |
$634.19 |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
698 |
649 |
$628.07 |
| 96376 |
|
102 |
92 |
$612.86 |
| 94060 |
|
54 |
32 |
$589.42 |
| 73110 |
|
116 |
97 |
$581.82 |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
358 |
344 |
$555.91 |
| J2785 |
Injection, regadenoson, 0.1 mg |
12 |
12 |
$544.35 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
13 |
13 |
$533.66 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
37 |
34 |
$491.90 |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
22 |
14 |
$486.91 |
| 82607 |
|
260 |
252 |
$482.66 |
| 84153 |
|
100 |
98 |
$434.76 |
| 87468 |
|
123 |
122 |
$430.31 |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
12 |
12 |
$399.98 |
| 82728 |
|
292 |
283 |
$398.77 |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
129 |
114 |
$365.25 |
| 73080 |
|
35 |
29 |
$363.14 |
| 83605 |
|
322 |
290 |
$347.16 |
| 87469 |
|
123 |
122 |
$344.50 |
| 82746 |
|
191 |
183 |
$338.64 |
| 87186 |
|
226 |
215 |
$319.52 |
| 87077 |
|
300 |
286 |
$309.66 |
| 93971 |
|
29 |
29 |
$290.48 |
| 81001 |
|
901 |
841 |
$288.49 |
| 87511 |
|
192 |
186 |
$277.60 |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
26 |
26 |
$272.20 |
| 96368 |
|
19 |
14 |
$264.36 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
161 |
144 |
$255.78 |
| 94010 |
|
41 |
26 |
$251.30 |
| 82043 |
|
237 |
235 |
$248.90 |
| 83690 |
|
449 |
423 |
$244.44 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
193 |
187 |
$201.32 |
| J2704 |
Injection, propofol, 10 mg |
301 |
283 |
$199.28 |
| 85610 |
|
435 |
321 |
$198.40 |
| 86140 |
|
385 |
346 |
$190.02 |
| 83550 |
|
258 |
252 |
$186.23 |
| 85027 |
|
396 |
348 |
$183.93 |
| 93976 |
|
12 |
12 |
$181.52 |
| 84100 |
|
160 |
122 |
$178.70 |
| 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 |
250 |
234 |
$167.89 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
84 |
58 |
$163.25 |
| 82948 |
|
359 |
206 |
$148.78 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
93 |
86 |
$146.06 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
234 |
232 |
$139.85 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
175 |
170 |
$139.19 |
| 83540 |
|
272 |
262 |
$137.54 |
| 86618 |
|
137 |
136 |
$128.65 |
| 82550 |
|
113 |
104 |
$114.61 |
| 82805 |
|
107 |
98 |
$113.07 |
| 73140 |
|
15 |
12 |
$110.32 |
| 71271 |
|
30 |
28 |
$108.04 |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
15 |
15 |
$102.71 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
113 |
111 |
$100.15 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
594 |
499 |
$93.34 |
| 84439 |
|
188 |
178 |
$91.36 |
| 88112 |
|
13 |
13 |
$87.78 |
| 86850 |
|
191 |
175 |
$85.55 |
| 86803 |
|
170 |
163 |
$82.71 |
| 92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
114 |
40 |
$82.34 |
| 80306 |
|
275 |
260 |
$78.51 |
| 82784 |
|
40 |
38 |
$76.83 |
| 99222 |
Initial hospital care, per day, moderate complexity |
40 |
38 |
$72.49 |
| 81003 |
|
413 |
393 |
$71.58 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
71 |
70 |
$67.14 |
| 85379 |
|
158 |
154 |
$65.08 |
| 87070 |
|
267 |
255 |
$64.71 |
| 85652 |
|
241 |
217 |
$58.93 |
| 86038 |
|
40 |
40 |
$55.66 |
| 86334 |
|
27 |
25 |
$53.86 |
| 80069 |
|
35 |
34 |
$53.54 |
| J1790 |
Injection, droperidol, up to 5 mg |
83 |
78 |
$48.37 |
| 84550 |
|
47 |
47 |
$40.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
425 |
377 |
$39.08 |
| 86200 |
|
12 |
12 |
$36.26 |
| 93018 |
|
27 |
27 |
$36.11 |
| 90715 |
|
31 |
30 |
$35.74 |
| 86900 |
|
188 |
173 |
$32.41 |
| 87040 |
|
112 |
102 |
$29.53 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
304 |
296 |
$29.22 |
| 83921 |
|
12 |
12 |
$27.16 |
| 84165 |
|
27 |
25 |
$26.72 |
| 82570 |
|
55 |
47 |
$24.28 |
| 86431 |
|
26 |
26 |
$23.54 |
| 87340 |
|
90 |
85 |
$21.63 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
183 |
173 |
$18.89 |
| 86901 |
|
190 |
174 |
$17.95 |
| 85730 |
|
118 |
110 |
$16.40 |
| J0134 |
Injection, acetaminophen (fresenius kabi), not therapeutically equivalent to j0131, 10 mg |
15 |
13 |
$16.21 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
138 |
105 |
$15.88 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
71 |
55 |
$14.70 |
| 85018 |
|
205 |
189 |
$14.60 |
| 84403 |
|
40 |
39 |
$12.96 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
94 |
77 |
$12.83 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
304 |
296 |
$12.53 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
315 |
302 |
$11.97 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
112 |
98 |
$11.05 |
| 84703 |
|
349 |
326 |
$9.42 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
94 |
57 |
$9.19 |
| G0145 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
150 |
146 |
$8.60 |
| 73590 |
|
14 |
13 |
$8.55 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
179 |
153 |
$8.02 |
| J2060 |
Injection, lorazepam, 2 mg |
97 |
87 |
$7.92 |
| 87205 |
|
45 |
41 |
$7.40 |
| 84156 |
|
31 |
28 |
$7.29 |
| 86706 |
|
14 |
14 |
$6.51 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
122 |
117 |
$5.92 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
312 |
277 |
$5.42 |
| 85014 |
|
13 |
12 |
$4.10 |
| 80305 |
|
293 |
257 |
$2.90 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
14 |
$2.90 |
| 81002 |
|
83 |
76 |
$2.64 |
| J3490 |
Unclassified drugs |
14 |
14 |
$1.79 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
15 |
14 |
$1.18 |
| 86780 |
|
143 |
138 |
$0.99 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
17 |
13 |
$0.68 |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
19 |
13 |
$0.62 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
46 |
43 |
$0.33 |
| 87081 |
|
64 |
61 |
$0.30 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
24 |
24 |
$0.07 |
| 81025 |
|
230 |
224 |
$0.00 |
| 84702 |
|
109 |
85 |
$0.00 |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
253 |
251 |
$0.00 |
| 83655 |
|
232 |
200 |
$0.00 |
| 87420 |
|
12 |
12 |
$0.00 |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
17 |
17 |
$0.00 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
253 |
251 |
$0.00 |
| 97802 |
|
44 |
44 |
$0.00 |
| 76801 |
|
16 |
14 |
$0.00 |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
54 |
28 |
$0.00 |
| 86762 |
|
41 |
38 |
$0.00 |
| 82950 |
|
48 |
46 |
$0.00 |
| 76819 |
Fetal biophysical profile; without non-stress testing |
35 |
15 |
$0.00 |
| 84402 |
|
15 |
14 |
$0.00 |