Visit Count 78
Patient #09975
Date of Birth: 02/08/1971 (48)
Primary Insurance: 1096 - United Healthcare (UH)
Referring Physician: Mark Miller
Date of Service: 07/25/2016
Provider: Shirley Jones, PT (101)
Case: 12/26/2018 - Revenue Center - 5
Posted: 08/01/2016
Location: BMS Testing ZZX OFFIX (OFFIC)
Date of Injury: 12/26/2018
| CPT Code | Units | Modifier 1 | Modifier 2 | Modifier 3 | Diagnosis Codes | POS Indicator | Insurance Preauthorization |
|---|---|---|---|---|---|---|---|
| L97421, 7197, 7295 | 11 | 356-07122016 | |||||
|
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L97421, 7197, 7295 | 11 | 356-07122016 |