Shoppable Services Service Choose one TRICARE PHP Daily – G0411 Tri/Medi Gero PHP – 5 units – G0411 Tri/Medi Gero PHP – 4 units – G0411 Tri/Medi Gero PHP – 3 units – G0411 Tri/Medi Gero PHP – 2 units – G0411 Tri/Medi Gero PHP – 1 units – G0411 Tri/Medi Gero PHP – 1 unit – G0411 Tri/Medi Gero IOP – 3 unit – 90853 Tri/Medi Gero IOP – 2 unit – 90853 Tri/Medi Gero IOP – 1 unit – 90853 Tri/Medi Child/Adol PHP- 5 un – G0411 Tri/Medi Child/Adol PHP ED – 5 units – G0177 Tri/Medi Child/Adol PHP ED – 4 units – G0177 Tri/Medi Child/Adol PHP ED – 3 units – G0177 Tri/Medi Child/Adol PHP ED – 2 units – G0177 Tri/Medi Child/Adol PHP ED – 1 unit – G0177 Tri/Medi Child/Adol PHP – 4 un – G0411 Tri/Medi Child/Adol PHP – 3 un – G0411 Tri/Medi Child/Adol PHP – 2 un – G0411 Tri/Medi Child/Adol PHP – 1 un – G0411 Tri/Medi Adult PHP ACT – 5 units – G0176 Tri/Medi Adult PHP ACT – 4 units – G0176 Tri/Medi Adult PHP ACT – 3 units – G0176 Tri/Medi Adult PHP ACT – 2 units – G0176 Tri/Medi Adult PHP ACT – 1 unit – G0176 Tri/Medi Adult PHP – 4 unit – G0411 Tri/Medi Adult PHP – 3 unit – G0411 Tri/Medi Adult PHP – 2 unit – G0411 Tri/Medi Adult PHP – 1 unit – G0411 Tri/Med Adult PHP – 5 unit – G0411 TRI/MCR GERO CD PHP 5 UNITS – G0411 TRI/MCR GERO CD PHP 4 UNITS – G0411 TRI/MCR GERO CD PHP 3 UNITS – G0411 TRI/MCR ADULT CD PHP 5 UNITS – G0411 TRI/MCR ADULT CD PHP 4 UNITS – G0411 TRI/MCR ADULT CD PHP 3 UNITS – G0411 Tri Gero IOP 1 unit – S9480 Tri Gero IOP – 3 unit – H0015 Tri Gero IOP – 2 units – H0015 TRI GERO CD IOP – H0015 TRI Adult IOP CD- 3 Units – H0015 TRI Adult IOP CD – 2 Units – H0015 Tri Adult IOP – 3 unit – 90853 Tri Adult IOP – 2 unit – 90853 Tri Adult IOP – 1 unit – 90853 TRI ADULT CD IOP – H0015 Tri Adol IOP – 3 unit – 90853 Tri Adol IOP – 2 unit – 90853 Tri Adol IOP – 1 unit – 90853 TRI ADOL CD PHP 5 UNITS – G0411 TRI ADOL CD PHP 4 UNITS – G0411 TRI ADOL CD PHP 3 UNITS – G0411 TRI ADOL CD IOP – H0015 Telehealth Tri/Medi Psych Adult IOP-3 units – 90853 Telehealth Tri/Medi Psych Adult IOP-2 units – 90853 Telehealth Tri/Medi Psych Adol IOP-1 unit – S9480 Telehealth Adult Psych IOP 3 hrs – 90853 Telehealth Adol Psych IOP 3 hrs – 90853 SUBSEQ HOSP (35 MIN) – 99233 SUBSEQ HOSP (25 MIN) – 99232 SUBSEQ HOSP (15 MIN) – 99231 Restoration bed charge – 110010 Psych Tx Group – 90853 PHP Daily Gero – H0035 PHP Daily Adult – H0035 PHP Daily – G0411 PHP CD GERO – H0035 PHP CD ADULT – H0035 PHP CD ADOL – H0035 PHP Adol/Child Psych 6hr – H0035 MCR IOP Gero CD 3 UNITS – 90853 MCR IOP Gero CD 2 UNITS – 90853 MCR IOP Adult- 4 units – 90853 MCR IOP Adult- 3 units – 90853 MCR IOP Adult – 2 units – 90853 MCR IOP Adult – 1 Unit – 90853 MCR ADULT IOP CD – 2 UNITS – 90853 MCR ADULT CD IOP – 3 UNITS – 90853 Low Functioning – 102000 LOA Adult – 101000 IP Acute Child/Adol – 103200 IP Acute Adult – 103100 IOP Child/Adol – S9480 IOP CD GERO – H0015 IOP CD ADULT – H0015 IOP CD ADOL – H0015 IOP Adult Daily Rate – S9480 Initial High – 99223 INIT HOSP CARE 50 MIN – 99222 INIT HOSP CARE 30 MIN – 99221 INDIVIDUAL PSYCHOTHERAPY – 90837 Indiv Psych Therapy – 90837 I/P Residential Stay – 610002 High Functioning Gero – 103000 Gero Psych PHP 6 hrs – H0035 Gero Psych IOP 3 hrs – 90853 Gero CD Rehab – 110007 ECT – 90870 DC >30 Minutes – 99239 DC <30 minutes - 99238 DBT Individual Therapy – 90785 DBT Group Therapy – 90853 Adult Psych PHP 6 hrs – H0035 Adult CD Rehab – 110008 Adol CD Rehab – 110009 Adol CD IOP 3 hrs – H0015 Acute Gero R&B – 124 Acute Gero Detox 3.7 – 110015 Acute Gero Detox – 126 Acute Gero Detox – 1002 Acute Child R&B – 124 Acute Adult R&B – 124 Acute Adult Detox 3.7 – 1000 Acute Adult Detox – 126 Acute Adult Detox – 1002 Acute Adol R&B – 124 Acute Adol Detox – 110013 Acute Adol Detox – 110006 ?> Insurance Provider Choose one aarp health care options aarp medicare complete administrative district council 1 welfar aetna aetna ama travel insurance aetna healthcare aetna medicare advantage aetna senior supplemental ins aflac supplemental allegiance benefit plan allell sunflower state health plan allianz global assistance allied benefits systems allied trades assistance program allsavers ambetter insurance ameriben american behavioral american continental insurance comapny american family ins american republic corp ins american republic insurance amerigroup amfirst anthem bcbs arizona medicare anthem bcbs medicare advantage anthem bcbs personal choice anthem blue cross blue shield anthem medi blue anthem medi blue of ohio anthem mediblue dual advantage apwu health plan apwu health plan issuer medco arapahoe county dept of human services arise health plan asi tricare retired supplement asr health assurant health auxiant phcs avanta phcs verdegard admin bankers fidelity bankers life barrick gold corp baylor scott white bcbs hmo colorado behavioral health inc ben e lect benefit management inc bind benefits inc blue card nasco blue cross blue shield blue cross blue shield of kansas blue cross community centennial boulder county dhs brand new day insurance bridge point bright health management bright health medicare advantage broadspire care improvement plus of texas care plus medicare care source carelon behavioral health carelon behavioral health strategies carelon bh apwu carelon bh employee asst carelon bh great west carelon bh kaiser carelon health colorado medicaid carelon medicare advantage carelon northeast health partners mcaid central states indemnity cfi retirement plan champva cigna cigna alliance health and life cigna behavioral health cigna greatwest healthcare cigna health partners inc cigna health spring medicare advantage cigna international cigna supplemental cigna true choice medicare ppo cigna zenith administrators clear springs health inc cnic cofinity colo community health alliance colonial penn med supplement colorado access colorado access advantage colorado access chp colorado health op combined ins of america commonwealth care alliance community care community health options compsych continental general insurace continental insurance marpai health coordinated benefit plan costilla county dhs coventry coventry health care cover colorado rocky mountain health csu funding dakatocare dean health plans denver health dhha denver health elevate silver denver health med plan cofinity denver health medical plan deseret healthcare employee dhs weld county dept of human services diversus health easy choice health plan ebms employer benefit service inc employers health network enterprise group planning inc equitable life and casualty insurance co equitable plan services evercare medicaid new mexico excellus bcbs medicare advantage fcbs federal blue cross fidelis medicare advantage first care first choice health network first health fmh benefit services freedom life ins friday health plans friday health plans chp fringe benefit group geha geha untied hlth integrated serv gerber life ins company ghi ghi bmp golden rule uhc gravie admin service aetna great southern life ins co group benefits guarantee trust life insurance hap aetna harvard pilgrim healthcare hca optum health alliance health comp administrators health ez health management concepts health net commercial claims healthchoice healthcomp integrated solutions llc healthscope healthscope benefits inc hemet community medical group hnfs tricare west houston casualty co humana gold choice humana healthcare humana tricare east huntsman mental health institute bhn hwbs claims illinicare health plan ilwu pma coastwise claims imagine 360 administrators innovage pace insurance management inc kaiser federal health benefit program kaiser of colorado kaiser of georgia kaiser of southern ca kaiser perm chp kaiser permanente kaiser permanente denver kaiser permanente kpic kaiser permanente northern kaiser permanente northwest kaiser permanente senior advantage hmo kaiser permanete of harrington kaiser southern california kayenta alternative rural hospital kemper insurance benefits kit carson county la health care plan larimer county dhs liberty healthshare life shield stm ins tpa lineco mental health substance abuse lucent health m care medical network maestro health magellan devoted health plans magellan health services magellan insurance mailhandlers managed care insurance mbr claims managed health network group manhatten life supplemental mayo health solutions mba tricare supplemental medcost ultra medica elect medicaid united healthcare medical mutual ins medicare united healthcare medico insurance supplement meritain health meritain health aetna choice pos merp administrative services mhnet mines and associates pc mitchell international moaa mediplus modern assistance program moffat county dhs molina healthcare of california molina healthcare of new mexico molina healthcare of texas molina healthcare of washington motivhealth mountain health co op multiplan mutual of omaha mvp healthcare value opts nalc health benefit plan nalc mcare secondary nationwide life ncsrcc health fund neighborhood health plan network health va nevada mediblue plus hmo new era life insurancce new mexico medicaid nikola tesia alternative high school northeast hp rmhp nova healthcare attn claims ohio casualty old surety life ins optima health plans optum empire health plan optum health behavioral solutions oxford health united behavioral health pacific source health plan pacificare behavioral health pai claims processing parkcare plus peak administration peak ppa penrose hospital phcs the health plan physicians mutual insurance company pinnacol assurance preferred one administrative services presbytarian healthcare presbyterian health plan priority health insurance private health care systems professional benefit administrators progressive group of insurance comp provider network of america psych care public employees health program pueblo county dhs pyramid life redirect health multiplan regional care inc reserve national reserve officers assoc insurance rio blanco county dhs rmhp commercial optun rmhp hmo optum rmhp medicare optum rmsco inc rocky mountain health plans medicaid rocky mountain human services rocky mountain life strategies rocky mountain pace rocky mtn pace routt county jail detention center safeco ins of america sanford health ins multiplan scan healthcare of arizona scott white health plans secure horizons secure horizons direct secure horizons medicare sedgwick select benefits administrators select health insurance select health medicare adv selman and company selman co sentinel life insurance sentinel security life sentinel security life ins company sharp community med grp secure horizon sheet metal workers shelter point sierra health life simplan insurance simplified benefits administrators simply healthcare special insurance services standard life and accident standard life and accident insurance starmark insurance state 12 short term state farm insurance state of co probation state restoration state short term states general life surest united health care teller county dhs the gemgroup thrivent financial for lutherns thrivent medicare supplement tlc benefits solution inc total long term care total longterm care inc trans america ins travelers insurance tricare europe region 13 tricare for life tricare north region tricare pacific region 14 tricare south region tricare west united healthcare tricare wps triwest tricare triwest va ccn claims trustmark small business benefits tufts health plan ucare uhc community plan uhc community plan az phys ipa umr umr cebt pm085516 umr united healthcare unicare state indeminity plan unified life insurance company united american insurance co united behavioral health united behavioral health of california united health care united health care new mexico united healthcare student resources united healthcare supplement united select health united world life unity health insurance upmc health plan usaa life ins valley health plan vantage health plans voans senior care community of colo volunteers of america natl assoc webb tpa wellcare of texas wellfleet winhealth woodmen of the world assured life associ wyoming pace zurich ?> Patient Age Choose one Adolescent Adult ?> View Report
