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SameOrSimilarReport THERESE HOOD

This document provides a report on claims for orthotics billed under various HCPCS codes for a patient. It lists claims data for ankle/knee/foot braces from 2016-2022, as well as codes for upper limb orthoses that had no claims found.

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57 views1 page

SameOrSimilarReport THERESE HOOD

This document provides a report on claims for orthotics billed under various HCPCS codes for a patient. It lists claims data for ankle/knee/foot braces from 2016-2022, as well as codes for upper limb orthoses that had no claims found.

Uploaded by

starsmarketing01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SAME OR SIMILAR REPORT

7/5/2023

QUERY CRITERIA
Request Id : 4316039 First Name : THERESE Last Name : HOOD
Member Id : 5QH0YH5RN25 DOB : 07/22/1954 State : SC
DOS Start : 07/05/2018 DOS End : 07/05/2023 Jurisdiction : C
Ref.Id/MRN : HCPCS : L3916,L3905,L3906,L3908,L3900,L3901,L3904,L3912,L3913,L3915,L3916,L3917,
L3918,L3919,L3921
RESULT

Status : Processed Message :

Error :

HCPCS Category DOS Start Unit Supplier Name Phone Status Notes/Error Same Category
HCPCS Billed
L1902KXRT Ankle/Knee/Foot 09/16/2016 1.0 ARCIS HEALTHCA RE, (843)797-5050 Allowed Yes
Brace LLC
L4361KXRT Ankle/Knee/Foot 04/20/2017 1.0 ARCIS HEALTHCA RE (843)797-5050 Allowed Yes
Brace
L0120 Cervical 10/11/2018 1.0 ARCIS HEALTHCA RE (843)797-5050 Allowed Yes
Orthotics
L1902KXRT Ankle/Knee/Foot 04/15/2019 1.0 ARCIS HEALTHCA RE (843)797-5050 Denied Yes
Brace
L4361KXRTRA Ankle/Knee/Foot 05/03/2022 1.0 ARCIS HEALTHCA RE (843)797-5050 Allowed Yes
Brace
L3916 Upper Limb No Claims No Claims Found No
Orthoses
L3905 Upper Limb No Claims No Claims Found No
Orthoses
L3906 Upper Limb No Claims No Claims Found No
Orthoses
L3908 Upper Limb No Claims No Claims Found No
Orthoses
L3900 Upper Limb No Claims No Claims Found No
Orthoses
L3901 Upper Limb No Claims No Claims Found No
Orthoses
L3904 Upper Limb No Claims No Claims Found No
Orthoses
L3912 Upper Limb No Claims No Claims Found No
Orthoses
L3913 Upper Limb No Claims No Claims Found No
Orthoses
L3915 Upper Limb No Claims No Claims Found No
Orthoses
L3916 Upper Limb No Claims No Claims Found No
Orthoses
L3917 Upper Limb No Claims No Claims Found No
Orthoses
L3918 Upper Limb No Claims No Claims Found No
Orthoses
L3919 Upper Limb No Claims No Claims Found No
Orthoses
L3921 Upper Limb No Claims No Claims Found No
Orthoses

Copyright@pVerify © 2023 Page 1 of 1

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