LPP Discounts and Adjustments
ICD-10 Codes That Insurers Do Not Feel Are Worthy of Medical Care and Coverage
Insurance Carrier Fun Facts
Story Problems
Allowable Amounts
The Only Patient with...
200

Therapy intake self-pay

What is $180?

200

Attention-Deficit Hyperactivity Disorder (ADHD), combined type

What is F90.2?

200

This company uses an organic-looking "tree of life" for most of its branding, but its Evernorth subsidiary has a much more bland and sterile "E" logo

What is Cigna?

200

If in-person visits take 37.8 seconds to submit, and telehealth claims take only 21.4 seconds to submit, this many Select Health claims can be submitted for Kaitlyn's patients on a typical Monday morning

What is zero?

200

Select Health Value Tiered follow-up

What is $185.74?

200

HMA

Who is JA?

400

Military and first responders discount

What is 25%?
400

Autism

What is F84.0?

400

Businesses whose employees use this insurer include Deseret News, Seagull Book, and the Polynesian Cultural Center

What is DMBA?

400

Treatment room 3 is open from 9:30-6:00. There are already two Spravato sessions booked at 2.5 hours each. Assuming optimal back-to-back scheduling is employed, we can fit this many ketamine sessions into the same block

What is one?

400

BCBS estimated intake

What is $281.41?

400

UPMC

Who is AK?

600
Injection self-pay
What is $20?
600

Postpartum depression

What is F53.0?

600

Beneficiaries for this program were originally offered one of three plans: an HMO, a PPO, or a "standard" plan

What is Tricare?

600

If Dylan the Provider works from 12:00-4:00 with two intakes and three follow-ups, this is his utilization rate

What is 87.5%?

600

UHC therapy follow-up

What is $110.30?

600

Pacific Source

Who is DS?

800

January Ketamine Package Discount (6)

What is $1,495?

800

Anorexia nervosa, restricting type (unspecified)

What is F50.01?

800

The two halves of this carrier's name originally were two separate companies, one covering hospital care and one covering physician services

What is Blue Cross Blue Shield?

800

Bill has met his deductible, so he only needs to pay 20% of the $110.30 allowed amount, or this much

What is $22.06?

800

Aetna Spravato

What is $258.36? (Or $268.36 counting B&B medication)

800

Health Scope

Who is KB?

1000

LM Disc B Family

What is $66.66?

1000

Oppositional Defiant Disorder

What is F91.3?

1000

This insurance company started as a fire insurer, and was named after Italy's tallest volcano

What is Aetna?

1000

Rhonda is seeing a provider today for an appointment with an allowed amount of $125.43, and she is $25.43 away from meeting her deductible. She has a 30% coinsurance after deductible. We should collect this much

What is $55.43?

1000

Cigna 99417 (add-on code only)

What is $50?

1000

SMBA PHCS Multiplan Network

Who is MR?