Billing Report

Nurse

Provider

Patient Name

Work Date
to

Last Name	First Name	DOB	Pt ID/MRN	Nurse	Provider	Work Date	Enrollment Date	Deactivation Date	# Days w/ Measurements	Training & Device Setup CPT 99453	Measurement 16 Days CPT 99454	RPM 20 min CPT 99457	RPM 40 min CPT 99458	RPM 60 min CPT 99458	CCM 20 min CPT 99490	CCM 40 min CPT 99439	CCM 60 min CPT 99487	Measurement 16 Days CPT 98977	Training & Device Setup CPT 98975	RTM 20 min CPT 98980	RTM 40 min CPT 98981	RTM 60 min CPT 98981	BHI 20 min CPT 99484