As paid vs. as it should have been
| Ln | Code | Description | Paid | Should be | Variance | Result |
|---|---|---|---|---|---|---|
| 1 | 99213 |
Office or other outpatient visit, established patient, low complexity
I10 · Essential (primary) hypertension
|
$94.22 | $94.22 | — | Correct |
Determination
Reviewed with no variance. Every line was paid at the allowable on file.
How it was coded
Remedy: None — the claim was billed and priced as the record supports
Reviewed for level, severity and unit count. Nothing billed above what the record carries.
Prior authorization
No prior authorization requirement for this service on this plan.
Policy applied
Knowledge CenterLevel selection for the visit billed
v4.2 was extracted from CPP-014_em-level-selection_v4.2.md. Passages are quoted only on the policy the finding rests on.
Coverage on the date of service
v6.1 was extracted from CPP-080_eligibility-enrolment-retroactive-termination_v6.1.md. Passages are quoted only on the policy the finding rests on.