| Code | Description | Claims | Beneficiaries | Total Paid |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
51,391 |
37,408 |
$509K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
3,341 |
3,128 |
$434K |
| 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 |
4,375 |
3,779 |
$297K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
7,906 |
2,647 |
$254K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
2,317 |
2,265 |
$192K |
| 80053 |
Comprehensive metabolic panel |
34,550 |
28,338 |
$192K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
4,514 |
3,959 |
$183K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
35,950 |
28,656 |
$153K |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
3,961 |
3,372 |
$138K |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
3,163 |
2,658 |
$130K |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
3,050 |
2,664 |
$104K |
| 70450 |
Computed tomography, head or brain; without contrast material |
2,738 |
2,556 |
$95K |
| 84443 |
Thyroid stimulating hormone (TSH) |
10,049 |
9,125 |
$84K |
| U0002 |
2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc |
2,142 |
2,073 |
$77K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
671 |
653 |
$75K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
3,147 |
1,190 |
$74K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
434 |
420 |
$67K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,711 |
1,665 |
$67K |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
112 |
111 |
$65K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
1,061 |
1,025 |
$55K |
| 36415 |
Collection of venous blood by venipuncture |
36,501 |
29,696 |
$54K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
724 |
703 |
$53K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
200 |
130 |
$43K |
| 71046 |
Radiologic examination, chest; 2 views |
4,171 |
3,968 |
$43K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
1,007 |
986 |
$42K |
| J0475 |
Injection, baclofen, 10 mg |
104 |
104 |
$41K |
| 97162 |
|
876 |
848 |
$40K |
| 84484 |
|
7,238 |
5,393 |
$38K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
578 |
553 |
$38K |
| J2785 |
Injection, regadenoson, 0.1 mg |
428 |
412 |
$36K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
70 |
69 |
$36K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
2,425 |
2,291 |
$35K |
| 83690 |
|
7,408 |
6,501 |
$35K |
| 76830 |
Ultrasound, transvaginal |
558 |
549 |
$33K |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
2,811 |
2,603 |
$32K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
593 |
586 |
$32K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
984 |
958 |
$31K |
| 84439 |
|
6,369 |
5,779 |
$31K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
983 |
958 |
$31K |
| 71045 |
Radiologic examination, chest; single view |
6,192 |
5,561 |
$29K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
2,494 |
1,803 |
$28K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,813 |
1,553 |
$27K |
| 83880 |
|
1,933 |
1,724 |
$25K |
| 87633 |
Infectious agent detection by nucleic acid, respiratory virus, 12-25 targets |
72 |
68 |
$24K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
751 |
374 |
$23K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
5,451 |
4,856 |
$23K |
| 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 |
677 |
626 |
$21K |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
3,888 |
2,931 |
$21K |
| 84703 |
|
2,897 |
2,724 |
$20K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
348 |
334 |
$20K |
| 76801 |
|
347 |
319 |
$19K |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
740 |
665 |
$19K |
| 81025 |
|
2,811 |
2,652 |
$19K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
5,321 |
4,004 |
$18K |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
142 |
140 |
$17K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
2,765 |
1,877 |
$17K |
| 87634 |
|
193 |
192 |
$15K |
| 76642 |
|
442 |
435 |
$15K |
| 80061 |
Lipid panel |
5,245 |
4,972 |
$15K |
| 97161 |
|
311 |
298 |
$15K |
| 81001 |
|
7,377 |
6,345 |
$14K |
| 81003 |
|
10,251 |
9,179 |
$14K |
| J2704 |
Injection, propofol, 10 mg |
4,261 |
3,721 |
$14K |
| 84702 |
|
906 |
726 |
$14K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
244 |
239 |
$14K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
7,024 |
6,580 |
$13K |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
25 |
25 |
$13K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
282 |
260 |
$13K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
85 |
81 |
$13K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
133 |
131 |
$13K |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
346 |
343 |
$13K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
3,449 |
3,120 |
$12K |
| 85610 |
|
7,373 |
5,651 |
$12K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
117 |
116 |
$11K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
3,097 |
2,298 |
$11K |
| 83605 |
|
1,499 |
1,252 |
$11K |
| 85027 |
|
3,049 |
2,653 |
$10K |
| 83735 |
|
3,619 |
2,718 |
$10K |
| 30140 |
|
13 |
13 |
$10K |
| 82728 |
|
1,601 |
1,490 |
$10K |
| 87077 |
|
2,129 |
1,944 |
$10K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
305 |
220 |
$9K |
| 82248 |
|
2,089 |
1,896 |
$9K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
5,985 |
4,774 |
$9K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
12 |
12 |
$9K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
666 |
512 |
$9K |
| 87186 |
|
1,641 |
1,519 |
$9K |
| 73630 |
|
1,024 |
969 |
$9K |
| 73610 |
|
840 |
784 |
$8K |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
8,895 |
7,492 |
$8K |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,699 |
4,802 |
$8K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
3,932 |
3,431 |
$8K |
| 71250 |
|
214 |
209 |
$8K |
| 73130 |
|
575 |
557 |
$8K |
| 72100 |
|
691 |
679 |
$8K |
| 87040 |
|
962 |
562 |
$8K |
| 85730 |
|
1,867 |
1,731 |
$7K |
| 85379 |
|
988 |
947 |
$7K |
| J1170 |
Injection, hydromorphone, up to 4 mg |
3,577 |
2,850 |
$7K |
| 86850 |
|
1,006 |
936 |
$7K |
| 74018 |
|
604 |
559 |
$7K |
| 82550 |
|
1,579 |
1,470 |
$7K |
| 86140 |
|
1,917 |
1,667 |
$6K |
| 73030 |
|
762 |
716 |
$6K |
| 97116 |
|
336 |
167 |
$6K |
| 73562 |
|
495 |
483 |
$6K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
539 |
524 |
$6K |
| 82607 |
|
1,721 |
1,582 |
$6K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
5,168 |
4,034 |
$6K |
| 62370 |
|
145 |
144 |
$5K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
340 |
318 |
$5K |
| 84466 |
|
848 |
791 |
$5K |
| 87430 |
|
400 |
394 |
$5K |
| 86900 |
|
1,328 |
1,229 |
$5K |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
142 |
137 |
$5K |
| 73502 |
|
644 |
617 |
$5K |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
996 |
942 |
$5K |
| 86901 |
|
1,326 |
1,228 |
$4K |
| 87210 |
|
928 |
475 |
$4K |
| 90715 |
|
226 |
222 |
$4K |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
112 |
104 |
$4K |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
5,408 |
4,477 |
$4K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
1,269 |
1,103 |
$4K |
| 82553 |
|
625 |
572 |
$4K |
| J0780 |
Injection, prochlorperazine, up to 10 mg |
556 |
514 |
$4K |
| 87070 |
|
655 |
593 |
$4K |
| 20610 |
|
372 |
313 |
$4K |
| 73564 |
|
516 |
502 |
$4K |
| 77066 |
Tomosynthesis, mammo |
53 |
53 |
$4K |
| 73110 |
|
285 |
273 |
$4K |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
56 |
56 |
$3K |
| 87280 |
|
228 |
224 |
$3K |
| 82803 |
|
171 |
162 |
$3K |
| 87081 |
|
425 |
415 |
$3K |
| 87420 |
|
220 |
217 |
$3K |
| 97163 |
|
54 |
54 |
$3K |
| 90834 |
Psychotherapy, 45 minutes with patient |
565 |
322 |
$3K |
| 83540 |
|
1,026 |
943 |
$3K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
171 |
93 |
$3K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
228 |
120 |
$3K |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
215 |
206 |
$2K |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
198 |
186 |
$2K |
| 85652 |
|
1,789 |
1,607 |
$2K |
| 82570 |
|
1,821 |
1,605 |
$2K |
| G0008 |
Administration of influenza virus vaccine |
1,528 |
1,496 |
$2K |
| G0378 |
Hospital observation service, per hour |
145 |
115 |
$2K |
| 84100 |
|
656 |
516 |
$2K |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
727 |
700 |
$2K |
| 76536 |
|
30 |
30 |
$2K |
| 87486 |
|
72 |
68 |
$2K |
| 87581 |
|
72 |
68 |
$2K |
| J2550 |
Injection, promethazine hcl, up to 50 mg |
953 |
823 |
$2K |
| 70496 |
|
14 |
13 |
$2K |
| 87481 |
|
13 |
12 |
$2K |
| 82784 |
|
133 |
129 |
$2K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
433 |
385 |
$2K |
| 73560 |
|
181 |
174 |
$2K |
| 90686 |
|
954 |
931 |
$2K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
758 |
425 |
$2K |
| 70498 |
|
12 |
12 |
$2K |
| 93296 |
|
403 |
381 |
$2K |
| 72040 |
|
175 |
165 |
$2K |
| 84156 |
|
535 |
466 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
217 |
135 |
$1K |
| 82746 |
|
328 |
306 |
$1K |
| 77080 |
|
151 |
151 |
$1K |
| 82043 |
|
962 |
921 |
$1K |
| 70486 |
|
24 |
24 |
$1K |
| 77065 |
Tomosynthesis, mammo |
29 |
26 |
$1K |
| 87340 |
|
49 |
49 |
$1K |
| 83615 |
|
258 |
196 |
$1K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,878 |
1,589 |
$1K |
| 87046 |
|
43 |
41 |
$1K |
| 73590 |
|
139 |
129 |
$1K |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
536 |
425 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$1K |
| 97014 |
|
81 |
34 |
$1K |
| 87205 |
|
371 |
327 |
$1K |
| 73090 |
|
58 |
49 |
$1K |
| 87511 |
|
13 |
12 |
$960.00 |
| 97166 |
|
12 |
12 |
$943.92 |
| 87427 |
|
82 |
41 |
$932.40 |
| J7050 |
Infusion, normal saline solution, 250 cc |
761 |
521 |
$891.30 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
401 |
218 |
$852.11 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
69 |
65 |
$835.78 |
| 84132 |
|
175 |
159 |
$827.94 |
| 51798 |
|
24 |
19 |
$814.66 |
| 86787 |
|
24 |
24 |
$800.52 |
| 87015 |
|
182 |
163 |
$791.26 |
| G0009 |
Administration of pneumococcal vaccine |
203 |
195 |
$786.21 |
| 97165 |
|
12 |
12 |
$785.46 |
| J2060 |
Injection, lorazepam, 2 mg |
1,111 |
975 |
$724.63 |
| J1644 |
Injection, heparin sodium, per 1000 units |
540 |
332 |
$707.47 |
| 82247 |
|
120 |
80 |
$672.18 |
| 76770 |
|
14 |
13 |
$658.89 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
636 |
519 |
$653.29 |
| 82565 |
|
126 |
120 |
$602.61 |
| 84481 |
|
27 |
27 |
$581.65 |
| 90662 |
|
273 |
269 |
$576.62 |
| 80164 |
|
75 |
64 |
$536.77 |
| 74220 |
|
12 |
12 |
$536.50 |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
13 |
12 |
$522.00 |
| 11720 |
|
531 |
521 |
$521.96 |
| 86780 |
|
24 |
24 |
$515.27 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
194 |
184 |
$514.92 |
| 90732 |
|
32 |
30 |
$477.52 |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
1,192 |
1,171 |
$454.56 |
| 73080 |
|
38 |
38 |
$450.33 |
| 86762 |
|
12 |
12 |
$448.00 |
| Q3014 |
Telehealth originating site facility fee |
348 |
252 |
$443.80 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
568 |
518 |
$438.36 |
| J1630 |
Injection, haloperidol, up to 5 mg |
508 |
444 |
$438.33 |
| 83970 |
|
16 |
15 |
$434.15 |
| 86039 |
|
52 |
48 |
$433.02 |
| 83516 |
|
30 |
24 |
$426.91 |
| 82950 |
|
14 |
14 |
$422.50 |
| 85007 |
|
130 |
113 |
$411.86 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,136 |
1,006 |
$402.00 |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
13 |
13 |
$389.97 |
| 87045 |
|
42 |
41 |
$377.64 |
| 86803 |
|
57 |
53 |
$302.73 |
| 93017 |
|
25 |
24 |
$280.14 |
| 87269 |
|
24 |
24 |
$266.40 |
| 87272 |
|
24 |
24 |
$266.40 |
| 97802 |
|
118 |
116 |
$261.59 |
| P9612 |
Catheterization for collection of specimen, single patient, all places of service |
146 |
142 |
$235.33 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$195.00 |
| 85300 |
|
26 |
26 |
$188.01 |
| 82140 |
|
20 |
13 |
$178.09 |
| J1815 |
Injection, insulin, per 5 units |
102 |
58 |
$175.51 |
| 72070 |
|
15 |
14 |
$173.38 |
| J8540 |
Dexamethasone, oral, 0.25 mg |
143 |
134 |
$169.14 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
32 |
24 |
$157.89 |
| J8597 |
Antiemetic drug, oral, not otherwise specified |
1,534 |
1,437 |
$149.86 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
1,874 |
1,690 |
$144.34 |
| 93299 |
|
177 |
176 |
$138.95 |
| 85018 |
|
50 |
45 |
$135.10 |
| 73620 |
|
13 |
13 |
$117.69 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
165 |
134 |
$107.39 |
| 87075 |
|
19 |
14 |
$106.15 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
110 |
93 |
$102.62 |
| 87177 |
|
12 |
12 |
$89.01 |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
41 |
41 |
$88.85 |
| G8980 |
Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting |
122 |
108 |
$87.50 |
| G8979 |
Mobility: walking & moving around functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
240 |
162 |
$87.50 |
| G8978 |
Mobility: walking & moving around functional limitation, current status, at therapy episode outset and at reporting intervals |
178 |
155 |
$87.50 |
| J0330 |
Injection, succinylcholine chloride, up to 20 mg |
52 |
52 |
$82.90 |
| 84153 |
|
15 |
15 |
$79.17 |
| 84550 |
|
24 |
24 |
$74.76 |
| 94060 |
|
13 |
13 |
$71.43 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
99 |
57 |
$68.76 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
25 |
25 |
$68.59 |
| 80177 |
|
15 |
13 |
$65.44 |
| 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 |
329 |
289 |
$61.23 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
18 |
15 |
$60.30 |
| 73552 |
|
13 |
13 |
$57.48 |
| 90791 |
Psychiatric diagnostic evaluation |
41 |
40 |
$53.89 |
| 94726 |
|
27 |
26 |
$49.43 |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
12 |
12 |
$48.22 |
| 97010 |
|
1,061 |
432 |
$40.00 |
| 86431 |
|
13 |
12 |
$35.00 |
| 80178 |
|
14 |
12 |
$29.36 |
| U0001 |
Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel |
25 |
24 |
$22.22 |
| 93922 |
|
14 |
13 |
$20.86 |
| 91320 |
|
16 |
16 |
$19.42 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
20 |
15 |
$11.15 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
39 |
37 |
$9.88 |
| P9603 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled |
382 |
295 |
$7.99 |
| 96376 |
|
122 |
97 |
$7.68 |
| 90653 |
|
40 |
39 |
$5.26 |
| 82962 |
|
101 |
99 |
$4.51 |
| A9270 |
Non-covered item or service |
52 |
25 |
$0.00 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
133 |
130 |
$0.00 |
| G8988 |
Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting |
13 |
12 |
$0.00 |
| G8987 |
Self care functional limitation, current status, at therapy episode outset and at reporting intervals |
12 |
12 |
$0.00 |
| 90694 |
|
121 |
119 |
$0.00 |
| 90656 |
|
48 |
48 |
$0.00 |
| 90480 |
|
16 |
16 |
$0.00 |
| 97597 |
|
17 |
14 |
$0.00 |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
486 |
216 |
$0.00 |
| 94729 |
|
51 |
50 |
$0.00 |
| 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 |
18 |
12 |
$0.00 |
| 0124A |
|
41 |
40 |
$0.00 |
| 11721 |
|
18 |
15 |
$0.00 |