Please use this page to submit a readable copy of my receipt for possible reimbursement from your insurance company. Please note, each plan is different with varying levels of benefits. The House Call visit may not be fully or even partially reimbursed.You may also submit my receipt to your Federal Savings Account for consideration. No codes are needed.
Write the appropriate code by each diagnosis on the receipt, as well as by the visit charge (new or established patient) and by any treatment charge (pulse ox, strep test, nebulizer treatment). If you do not find your diagnosis on the list, please email me (heidi.j.johnson@gmail.com). Make a readable copy of the receipt and send that, along with a note asking for consideration for reimbursement, to your insurance carrier. Some carriers may ask you to fill out their form. If so, use this information to complete the form. My tax ID number and license number are on the top of the receipt if needed. If not, please list it in by my name: #27-0985640.
Note: Medications are not reimbursable. New patient means the first time I come to your house, established patient means subsequent visits.
- AGE: 558
- Abrasion: 911.0
- Asthma (stable): 493.0
- Asthma Exacerbation: 493.22
- Balanitis: 607.1
- Bronchiolitis: 466.19
- Bronchitis: 466.0
- Bronchospasm: 519.11
- Cat Bite: E906.3
- Cerumen Impaction: 380.4
- Conjunctivitis: 372.0
- Contact Dermatitis: 692
- Costochondritis: 733.6.
- Coxsackie: 074.0
- Croup 464.4
- Candidial Diaper Rash: 112.1
- Diaper Rash: 691.0
- Dog Bite: E906.0
- Epistaxis: 784.7
- Eczema: 691.8
- Face: 873.40
- Fall: E885.9
- Fever: 780.6
- Fifth Disease: 057.0
- Folliculitis: 704.8
- Foreign Body (Ear): 931
- Foreign Body Removal (Ear) (“Procedure Code”): 69200
- Foreign Body (Nose): 932
- Foreign Body Removal (Nose) (“Procedure Code”): 30300
- Foreign Body (Splinter) of foot without infection: 917.6
- Foreign Body (Splinter) of foot: infected: 917.7
- Fussy Baby: 780.91
- Heart Murmur: 785.2
- Herpangina: 074.0
- Human Bite: E928.3
- Impetigo: 684
- Influenza: 487
- Insect Bites: 919.4
- Jaundice: 774.6
- Laceration (open wound) of face: 873.40
- Laceration repair (simple repair of open wounds of face) (“Procedure Code”): 12011
- Laceration of mouth (open wound, uncomplicated): 873.60
- Molluscum Contagiosum: 078.0
- Nasolacrimal Duct Obstruction 375.56
- Nebulizer Treatment (“Procedure Code”): 94640 #1 / 94640-76: #2 & #3
- Nevus: 448.1
- Newborn Feeding Problem: 779.3
- OM (L or R): 382.9
- PCN Allergy: V14.01
- Petechiae: 782.7
- Pharyngitis: 462
- Pneumonia: 482
- Pulse Ox (“Procedure Code”): 94760
- Purulent OM: 382.4
- Rapid Strep Test (“Procedure Code”): 87880QW
- Respiratory Distress: 786.09
- Seborrhea: 706.3
- SOM (L, R or B): 381.01
- Strep Pharyngitis: 034.0
- Suture Removal (Procedure Code”): V58.32
- Teething: 526.7
- Tinea Corporis: 110.5
- URI: 465
- Urticaria: 708
- Viral Illness: 79.99
- Visit Charge (“Procedure Code”): 99343-new pt/ 99348-est. pt/ 99344-new pt for Wheezing/asthma visit (est. pt=99350)
- Vomiting: 787.03
- Well Child Exam v20.2
- Weight Loss: 783.21
- Wheezing: 786.07