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"CPT", "billing_code_type_version": "2026", "billing_code": "98941", "description": "Chiropractic manipulative treatment (CMT); spinal, 3-4 regions", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1215032289" }, "billing_class": "professional", "payments": [ { "allowed_amount": 45.17, "providers": [ { "billed_charge": 55.0, "npi": [ 1215032289 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1629035571" }, "billing_class": "professional", "payments": [ { "allowed_amount": 51.34, "providers": [ { "billed_charge": 60.0, "npi": [ 1629035571 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1629071030" }, "billing_class": "professional", "payments": [ { "allowed_amount": 45.68, "providers": [ { "billed_charge": 55.0, "npi": [ 1629071030 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS", "billing_code_type": "CPT", "billing_code_type_version": "2026", "billing_code": "98942", "description": "Chiropractic manipulative treatment (CMT); spinal, 5 regions", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1851693873" }, "billing_class": "professional", "payments": [ { "allowed_amount": 58.54, "providers": [ { "billed_charge": 75.0, "npi": [ 1851693873 ] } ], "billing_code_modifier": [ "AT" ] } ], "service_code": [ "11" ] } ] }, { "name": "CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION", "billing_code_type": "CPT", "billing_code_type_version": "2026", "billing_code": "98943", "description": "Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1669533626" }, "billing_class": "professional", "payments": [ { "allowed_amount": 30.77, "providers": [ { "billed_charge": 50.0, "npi": [ 1669533626 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1851693873" }, "billing_class": "professional", "payments": [ { "allowed_amount": 29.22, "providers": [ { "billed_charge": 85.0, "npi": [ 1851693873 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2026", "billing_code": "99233", "description": "Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1326206822" }, "billing_class": "professional", "payments": [ { "allowed_amount": 152.49, "providers": [ { "billed_charge": 200.0, "npi": [ 1326206822 ] } ] } ], "service_code": [ "21" ] } ] }, { "name": "INFUS SPL EXT RX INFUS PUMP CASSETTE/BAG", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "A4222", "description": "Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1376720482" }, "billing_class": "professional", "payments": [ { "allowed_amount": 430.46, "providers": [ { "billed_charge": 1137.14, "npi": [ 1376720482 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "DISPBL DRUG DELIV SYSTEM FLOW RATE 50 ML/>-HOUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "A4305", "description": "Disposable drug delivery system, flow rate of 50 ml or greater per hour", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1376720482" }, "billing_class": "professional", "payments": [ { "allowed_amount": 228.55, "providers": [ { "billed_charge": 758.1, "npi": [ 1376720482 ] } ] } ], "service_code": [ "12" ] } ] }, { "name": "DEPRESSION ANXIETY APATHY & PSYCHOSIS ASSESSED", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G2121", "description": "Depression, anxiety, apathy, and psychosis assessed", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1437653953" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 36.0, "npi": [ 1437653953 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "BMI DOC ABOVE NORMAL PARAM & F/U PLAN DOCUMENTED", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G8417", "description": "BMI is documented above normal parameters and a follow-up plan is documented", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043206980" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 1.0, "npi": [ 1043206980 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1790864593" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1790864593 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "ELIG CLIN ATTSTS DOC M REC OBTD UPD/REV PT MEDS", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G8427", "description": "Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043206980" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 1.0, "npi": [ 1043206980 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1063402741" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1063402741 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1790864593" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1790864593 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "MOST RECENT SYSTOLIC BLOOD PRESSURE < 140MM HG", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G8752", "description": "Most recent systolic blood pressure < 140 mm Hg", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043206980" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 1.0, "npi": [ 1043206980 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "MOST RECENT DIASTOLIC BLOOD PRESSURE < 90MM HG", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G8754", "description": "Most recent diastolic blood pressure < 90 mm Hg", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043206980" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 1.0, "npi": [ 1043206980 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "NORMAL BLOOD PRESS READING DOC F/U NOT REQUIRED", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G8783", "description": "Normal blood pressure reading documented, follow-up not required", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1063402741" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1063402741 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "PATIENT NOT ELIGIBLE D/T ACTIVE DX HYPERTENSION", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G9744", "description": "Patient not eligible due to active diagnosis of hypertension", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043206980" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 1.0, "npi": [ 1043206980 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "PATIENT SCR TOBACCO USE & ID AS TOB NON-USER", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "G9903", "description": "Patient screened for tobacco use and identified as a tobacco nonuser", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1790864593" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1790864593 ] } ] } ], "service_code": [ "11" ] }, { "tin": { "type": "npi", "value": "1982635173" }, "billing_class": "professional", "payments": [ { "allowed_amount": 0.0, "providers": [ { "billed_charge": 0.01, "npi": [ 1982635173 ] } ] } ], "service_code": [ "11" ] } ] }, { "name": "INJECTION MEROPENEM 100 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2026", "billing_code": "J2185", "description": "Injection, meropenem, 100 mg", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1376720482" }, "billing_class": "professional", "payments": [ { "allowed_amount": 10.5, "providers": [ { "billed_charge": 960.0, "npi": [ 1376720482 ] } ] } ], "service_code": [ "11" ] } ] } ] }