Billing Version 0.0089897

Charge Audit - Released Charges

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
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Patient #786543 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
James Peterson (786543) 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
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
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Patient #246121 Date of Birth Age Primary Insurance Date of Service Provider Location Posted
Mark Miller (246121) 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
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
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