Validated
READY TO SUBMIT
All 9 AI checks and 6 clearinghouse edits passed at 10:10 AM
Claim score
98/100
Estimated risk
LOW
Est. reimbursement
$425
Claim Summary
| Line | CPT | Description | Mod | Dx | Charge |
|---|---|---|---|---|---|
| 1 | 99204 | Office visit, new patient, moderate complexity | 25 | M17.11 | $245.00 |
| 2 | 20610 | Arthrocentesis, major joint — knee injection | RT | M25.561 | $198.00 |
| 3 | 73562 | Radiologic exam, knee, 3 views | RT | G89.29 | $85.00 |
| Total charges | $528.00 | ||||
Modifier 25 appended to 99204
Authorization AUTH-UHC-449021 attached
Assessment addendum linked to M17.11
Reimbursement Forecast
Total charges$528.00
Contractual allowed$455.00
Patient responsibility$78.52
Expected insurance payment$425.00
Expected payment date08/09/2026
Denial probability4%
Submission Details
Transaction837P v5010
ClearinghouseNetRev AI EDI
Payer ID87726
Billing providerDr. Michael Carter