Billing Version 0.0089897
Visit Count :  78
Patient #246477 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
Sam Smith (246477) 05/07/1968 48 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
97201 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97545 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018

Patient #56432 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
James Miller (56432) 01/03/1972 48 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
94532 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97678 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018

Patient #89764 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
Chris Allan (89764) 09/02/1972 54 1096 - United Healthcare (UH) 07/25/2016 Shirley Jones, PT (101) BMS Testing ZZX OFFIX plsA (OFFIC) 08/01/2016
 
CPT Code Units Modifier 1 Modifier 2 Diagnosis Codes POS Indicator Insurance Preauthorization Referring Physician Case Date of Injury
97011 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018
97001 1 RT CJ L97421, 7197, 7295 356-07122016 Mark Miller 12/26/2018 - Revenue Center - 5 12/26/2018