CMS Shoppable Services
#
Code
Description
Available
1
90832
Psychotherapy, 30 minutes with patient
N/A
2
90834
Psychotherapy, 45 minutes with patient
N/A
3
90837
Psychotherapy, 60 minutes with patient
N/A
4
90846
Family psychotherapy
N/A
5
90847
Family psychotherapy including patient
N/A
6
90853
Group psychotherapy
N/A
7
99203
New patient ofice visit, complex
YES
8
99204
New patient office or other outpatient visit, typically 45 min
YES
9
99205
New patient ofice visit, comprehensive visit
N/A
10
99243
Office visit consultation, complex
N/A
11
99244
Office consultation - new or established patient - 60 min
N/A
12
99385
Initial new patient preventative medicine evaluation (18-39 years)
YES
13
99386
Initial new patient preventative medicine evaluation (40-64 years)
N/A
14
80048
Blood test, basic group of blood chemicals
YES
15
80053
Blood test, comprehensive group of blood chemicals
YES
16
80055
Obstetric panel (includes HIV testing)
N/A
17
80061
Blood test, lipids (cholesterol and triglycerides)
YES
18
80069
Kidney Function Blood Test Panel
YES
19
80076
Liver function blood test panel
YES
20
81000
Manual urinalysis test with examination using microscope
YES
21
81001
Urinalysis with Examination, using Microscope
YES
22
81002
Urinalysis, Manual Test
YES
23
81003
Urinalysis, Automated Test
YES
24
84153
PSA (prostate specific antigen) measurement
YES
25
84154
PSA Measurement; Free
YES
26
84443
Blood test, thyroid stimulating hormone (TSH)
YES
27
85025
Complete blood cell count - automated differential WBC count
YES
28
85027
Complete blood cell count - automated test with out Differential
YES
29
85610
Blood test, clotting time
YES
30
85730
Coagulation assessment blood test
YES
31
70450
CT Head Brain without Contrast
YES
32
70553
MRI Brain with and without Conrast
YES
33
72110
X-Ray Lower Sacral Spine, 4 or More Views
YES
34
72148
MRI Spine Lumbar without Contrast
YES
35
72193
CT Pelvis with Contrast
YES
36
73721
MRI Leg Joint without Contrast
YES
37
74177
CT Abdomen & Pelvis with Contrast
YES
38
76700
Ultrasound Abdomen - Complete
YES
39
76805
Ultrasound Pregnant Uterus > 14 Weeks Pregnant
YES
40
76830
Ultrasound Pelvis through Vagina
YES
41
77065
Diagnostic mammography, unilateral
N/A
42
77066
Diagnostic mammography, bilateral
N/A
43
77067
Screening Mammography, Bilateral, with CAD
N/A
44
216
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
N/A
45
460
Spinal fusion other than the neck without major complications
YES
46
470
Total Knee or Hip Replacement
YES
47
473
Cervical spinal fusion without complications
YES
48
743
Uterus or Ovary Surgery Not Related to Cancer without complications
YES
49
19120
Removal of 1 or more breast growth, open procedure
YES
50
29826
Shaving of shoulder bone using an endoscope
YES
51
29881
Removal of one knee cartilage using an endoscope
YES
52
42820
Removal of tonsils and adenoid glands patient younger than age 12
YES
53
43235
Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope
YES
54
43239
Biopsy of the Esophagus, Stomach, Using an Endoscope
YES
55
45378
Colonscopy
YES
56
45380
Biopsy of Large Bowel, Using an Endoscope
YES
57
45385
Removal of Polyps in Large Bowel, Using an Endoscope
YES
58
45391
Ultrasound examination of lower large bowel using an endoscope
N/A
59
47562
Gallbladder Removal Using an Endoscope
YES
60
49505
Repair of groin hernia patient age 5 years or older
YES
61
55700
Biopsy of prostate gland
YES
62
55866
Surgical removal of prostate and surrounding lymph nodes using an endoscope
N/A
63
59400
Routine obstetric care for vaginal delivery, including pre and post
N/A
64
59510
Routine obstetric care for cesarean delivery, including pre and post
N/A
65
59610
Routine obstetric care for vaginal delivery after prior cesarean delivery, including pre and post
N/A
66
62322
Injection of substance into spinal canal or lower back using imaging
N/A
67
62323
Epidural Injection Thoracic
YES
68
64483
Injection of anesthetic and/or steroid into lower spine nerve root using imaging
YES
69
66821
Removal of recurring cataract in lens capsule using laser
N/A
70
66984
Removal of cataract with insertion of lens
N/A
71
93000
Routine electrocardiogram
N/A
72
93452
Insertion of catheter into left heart for diagnosis
N/A
73
95810
Sleep monitoring of patient (6 years or older) in sleep lab
YES
74
97110
Physical Therapy Exercise, 15 Minutes
YES

This link leads to the downloadable machine-readable file of all items and services provided by this facility as required by CMS. Please be advised the file size may exceed 1.5 gigabytes and therefore may take an extended amount of time to download depending on each individual user’s internet speed, bandwidth, connectivity, available hard drive space, etc.

Disclaimer

In compliance with federal law, Western Reserve Hospital is pleased to provide our patients good faith estimates of what the cost could be for certain services.

However, these estimates do not show what your final out-of-pocket costs may be. Final costs will vary based on your insurance benefits, including deductible or maximum out-of-pocket expenses. Final determination of eligibility and services covered are determined at the time the claim is processed by the insurance company. The amount you owe may be different. We encourage you to contact your insurance company to confirm your benefits at the time of service as these estimated costs are not a guarantee of insurance coverage. Any services determined non-covered by your plan are your responsibility to pay.

This good faith estimate also does not include bills from medical specialists, including, but not limited to: physician charges, anesthesiology charges, radiologist reading fees and pathologist fees. Charges from these medical specialists will be billed separately to you.

  • Pre-Procedure Office Visits
  • Post-Procedure Office Visits
  • Diagnostic Testing

Final costs will vary based upon your specific needs at the time of the service, which may include additional treatments or services deemed necessary by your physician.

To obtain the most accurate estimate of patient out of pocket costs, it is strongly recommended that patients contact their insurer to request an estimate or Patient Financial Coordinator at 330-971-7597. To obtain the most accurate estimate possible, the patient's insurance information and a specific description of the service requested [preferably a physician's order], are necessary.

Please contact our Patient Financial Coordinator at 330-971-7597 for a customized estimate of patient responsibility based upon your insurance. Regular business hours are Monday - Friday, 8 a.m. - 4:30 p.m.

For patients who have little or no health insurance, Western Reserve Hospital offers a variety of services. Please contact our Patient Financial Coordinator at 330-971-7597 for more information on our charity care program or for an uninsured discount. Western Reserve Hospital also provides support to patients who need help determining their eligibility for Medicaid and other financial support services.

If you need an interpreter or other assistance in using this tool, please visit

https://www.westernreservehospital.org/patients-and-visitors/notice-of-non-discrimination.aspx

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I HAVE READ AND UNDERSTAND THE ABOVE LIMITATIONS AND I FULLY UNDERSTAND THIS IS ONLY A GOOD FAITH ESTIMATE INTENDED ONLY FOR THE USE OF THE INTENDED RECIPIENT. I understand and agree