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CMS-1500 Health Insurance Claim (Draft)
ROBERT ALVAREZ•Drafted just now•Ready for review
CPT 99214•1.92 wRVU•Est. ~$134 CMS
CMS 2026 CodebookNuance-Calibrated NUCC Claim Mapping:
- Box 1a (Insured ID): BCBS-48810294-A
- Box 2 (Patient Name): ALVAREZ, ROBERT (DOB: 06/14/1978 • Male)
- Box 21 Primary Diagnosis: J45.51 (Severe persistent asthma with acute exacerbation)
- Box 24D Procedure / Service Code: CPT 99214 (Level 4 Established Office Visit) • Pointer: A
- Box 24E Diagnosis Pointer: A
- Box 28 Total Charges: $195.00
- Box 31 Physician Signature: Marcus Vance, MD (Signing provider) • NPI: 1942810924
Doc 1 of 6•Use ← → keys to sweep
Provider review (31 U.S.C. § 3729)
Source • Patient Encounter Chart • Assessment & Plan