| Procedure Master Report |
| | | | | |
| Reno Behavioral Healthcare Hospital LLC. | Transaction Type: Charge |
| Procedure Master Report | Revenue Code: All |
| Report Date: 12/29/2020 | | | |
| | | | | |
| Proc Cd | Description | Rev Cd | HCPCS | Default Amount |
| 17000077 | ADMIT KIT | 270 | | $ 25.00 |
| 17000101 | R&B SEMI PRIVATE | 124 | | $ 1,600.00 |
| 17000124 | R&B SEMI-PRIVATE PSYCHIATRIC | 124 | | $ 1,600.00 |
| 17000126 | R&B SEMI PRIVATE DETOX | 126 | | $ 1,600.00 |
| 17000128 | R&B Semi-Private Rehab | 128 | | $ 1,600.00 |
| 17000204 | R&B SEMI PRIVATE | 124 | | $ 1,600.00 |
| 17000205 | R&B PSYCH INTENSIVE CARE | 124 | | $ 2,400.00 |
| 17000762 | OBSERVATION HOLD | 762 | | $ 825.00 |
| 17000904 | GROUP PSYCHOTHERAPY/ACTIVITY THERAPY | 904 | G0176 | $ 160.00 |
| 17000915 | CD PARTIAL | 911 | 90853 | $ 525.00 |
| 17000942 | GROUP PSYCHOTHERAPY/EDUCATION | 942 | G0177 | $ 160.00 |
| 17001119 | SPRAVATO PHYSICIAN | 961 | | $ 200.00 |
| 17001120 | SPRAVATO OBSERVATION | 510 | | $ 300.00 |
| 17001510 | BRIDGE SESSION BILLING | 513 | | $ 200.00 |
| 17001915 | PSYCH PARTIAL | 912 | 90853 | $ 525.00 |
| 17052319 | R&B SEMI PRIVATE EATING DISORDERS | 124 | | $ 1,600.00 |
| 17052320 | RTC R&B | 138 | | $ 1,600.00 |
| 17072190 | PELVIC ULTRASOUND | 402 | 76856 | $ 502.00 |
| 17090853 | GROUP PSYCHOTHERAPY | 915 | G0410 | $ 160.00 |
