Unique Plan Description: Diabetes Management Services Clinic
Plan Selection Display: Diabetes Management Services Clinic
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-28 20:01:39
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-06 08:56:35
Available at all facilities: No

Diabetes Management Services Clinic
Consults/Follow-up
	Follow-up Appointment
		Follow Up Visit, 1 month
		Follow Up Visit, 1 week
		Follow Up Visit, 2 weeks
		Follow Up Visit, 3 weeks
		Follow Up Visit, 3 months
		Follow Up Visit, 6 months
		Follow Up Visit, 1 year
		Follow Up Visit, See Special Instructions
Charges/Supplies
Est. Pt Visit
	99211 EVM - OP visit estab patient, minimal care < 10 min
		T;N
	99212 EVM - OP VISIT ESTAB PATIENT, STRAIGHTFORWARD 10 MIN
		T;N
	99213 EVM - OP VISIT ESTAB PATIENT, LOW LEVEL 20 MIN
		T;N
	99214 EVM - OP VISIT ESTAB PATIENT, MODERATE 30 MIN
		T;N
	99215 EVM - OP VISIT ESTAB PATIENT, HIGH LEVEL 40 MIN
		T;N
New Pt Visit
	zz99201 EVM-New Pt Visit Problem focused 10m
		T;N
	99202 EVM - OP VISIT NEW PATIENT, STRAIGHTFORWARD 15 MIN
		T;N
	99203 EVM - OP VISIT NEW PATIENT, LOW LEVEL 30 MIN
		T;N
	99204 EVM - OP VISIT NEW PATIENT, MODERATE LEVEL 45 MIN
		T;N
	99205 EVM - OP VISIT NEW PATIENT, HIGH LEVEL 60 MIN
		T;N
Prolonged Care
	99354 EVM - Prolonged Care, Outpatient, 1 Hr
		T;N
	99355 EVM - Prolonged Care, Outpatient, Ea Addl 30 Min
		T;N
Procedures in Office
	95250 Ambulatory Continuous Glucose Monitoring
		
	Follow-Up Eval Diabetic Foot PT LOPS -G0246
		
	IND Diabetes Skills/Management Ed
		
	Initial Foot Diabetic PT LOPS -G0245

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase