습 Service CPT Usual Charge Mountville Health Plan Allowed Charge Medicare Allowed Charge Office/Outpatient Visit, New, M

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습 Service CPT Usual Charge Mountville Health Plan Allowed Charge Medicare Allowed Charge Office/Outpatient Visit, New, Min. 99201 $54 $48 $43 Office/Outpatient Visit, New, Low 99202 $73 $65 $58 Office/Outpatient Visit, New, Mod. 99203 $100 $89 $80 Office/Outpatient Visit, New, Mod. 99204 $147 $129 $116 Office/Outpatient Visit, New, High 99205 $190 $168 $151 Office/Outpatient Visit, Est., Min. 99211 $29 $26 $22 Office/Outpatient Visit, Est., Low 99212 $44 $39 $35 Office/Outpatient Visit, Est., Mod. 99213 $60 $54 $48 Office/Outpatient Visit, Est., Mod. 99214 $87 $78 $70 Office/Outpatient Visit, Est., High 99215 $134 $119 $107

III < 95 of 224 > Q Аа 6 1 Rhythm ECG with Report 93040 $30 $36 $30 Breathing Capacity Test 94010 $83 $69 $58 DTAP Immunization 90700 $102 $87 $74 A. LO 6.6-6.9 Insurance Plan: Mountville Health Plan; patient has met annual deductible of $250; 80-20 Page 216 coinsurance Services: CPT 99203, 90700 Payer Reimbursement: Patient Charge: B. LO 6.6–6.9 Insurance Plan: Mountville Health Plan; patient has paid $125 toward an annual deductible of $500; 80- 20 coinsurance Services: CPT 99215, 93040, 94010 Payer Reimbursement: Patient Charge: C. LO 6.6–6.9 Insurance Plan: Ringdale Medical Plan A; no deductible or coinsurance; copayment of $5/PAR; $25/NonPAR Services: CPT 99212

D. LO 6.6-6.9 Insurance Plan: Ringdale Medical Plan B; patient has met annual deductible of $300; 80-20 coinsurance Services: CPT 99215 Payer Reimbursement: Patient Charge: E. LO 6.6–6.9 Insurance Plan: Medicare; annual deductible has been met by patient Services: 99213, 93040 Payer Reimbursement: Patient Charge:

III < 95 of 224 > Aa s correct spreadsheet. • In the spreadsheet that loads, CPT codes will be listed on the left, and a GLOB DAYS column will contain their corresponding global periods. A. 11010 B. 17106 C. 20931 D. 28005 E. 31238 F. 33933 G. 42330 H. 54318 1. 58321 J. 66155