Innova Primary Care Home Page - Innova Primary Care

Mending people.

Mending standards.

Access Patient Portal

Schedule Appointment

New patient?

Innova Telehealth

Access Patient Portal

Schedule Appointment

Innova Telehealth

New patient?

Non-Covered Services (9/15/2020)	Innova Fee
Each page of medical paperwork, letters or forms for completion within 5 business days.	$10.00
Expedited processing for medical paperwork, letters or forms for completion within 2 business days.	$25.00
Each Clinical response to a patient portal inquiry outside of an appointment or Medicare e-visit.	$10.00
After hour and holiday phone consultations or appointments.	$50.00
Results already provided on the portal, printed and mailed outside an appointment	$15.00

Non-Service Fees (9/15/2020)	Innova Fee
Patient late cancellation fee (less than 24 hours notice/10 minutes late for appointment).	$25.00
Patient no-show fee for missing a scheduled appointment.	$50.00

*Some of the most commonly provided services at Innova	Innova Fee	CPT Code
*Established Patient Office Visit Level 3	$108.00	99213
*Established Patient Office Visit Level 4	$154.00	99214
*Injection in deep muscle or subcutis	$29.00	96372
*Medical Service provided on holiday eve, holiday or weekend	$28.00	99051
*Chronic Care Management (Medicare program)	$61.00	99490
*Established Patient Preventive Care for Age 18 - 39 years old	$123.00	99395
*Established Patient Preventive Care for Age 40-64 years old	$134.00	99396
*In office Flu Swab	$17.00	87804
*Immunization injection administered	$29.00	90471
*Steroid (Injectable) Medication	$8.00	J0702
Treatment of used to clear a skin lesion of pus to start the healing process	$172.00	10060
Treatment of used to clear a skin lesion of pus to start the healing process	$298.00	10061
Procedure where a small round piece of tissue is sent to the lab for biopsy	$176.00	11104
Skin tag removal of 1 lesion	$125.00	11200
Skin tag removal of more than 1 lesion	$27.00	11201
Shave removal of skin lesion on midsection less than 0.5 cm	$140.00	11300
Shave removal of skin lesion on midsection 0.6 cm to 1.0 cm	$170.00	11301
Shave removal of skin lesion on midsection 1.0 to 1.2 cm	$197.00	11302
Shave removal of a single lesion, scalp, neck, hands, feet, genitalia	$173.00	11306
Shave removal of a single lesion, face, ears, eyelids, nose, lips less than 0.5 cm	$162.00	11310
Shave removal of a single lesion, face, ears, eyelids, nose, lips 0.6 cm to 1 cm	$193.00	11311
Shave removal of a single lesion, face, ears, eyelids, nose, lips 1.0 cm to 2.0 cm	$223.00	11312
Excision of benign (normal) lesion including margins 0.6 cm to 1 cm	$215.00	11401
Wound or cut greater or equal to 2 cm	$128.00	12001
Removal of first lesion	$92.00	17000
Removal of 2 to 14 skin lesions (1 additional unit for each)	$9.00	17003
Removal of 15 or more skin lesions	$222.00	17004
Removal of skin lesions	$485.00	17106
Removal of 1 to 14 skin lesions	$156.00	17110
Cryo (freezing) treatment of skin	$76.00	17340
Small joint or bursa injection	$73.00	20600
Intermediate joint or bursa injection	$75.00	20605
Marge joint or bursa injection	$89.00	20610
Removal of unspecified object from eye	$70.00	65205
Removal of unspecified object from ear	$149.00	69200
Removal of impacted ear wax	$20.00	69209
Ear Cleaning	$69.00	69210
Imaging Exam	$43.00	76000
Ultrasound for soft tissue for head and neck	$118.00	76536
Chest Ultrasound	$82.00	76604
Complete Breast Ultrasound	$110.00	76641
Limited Breast Ultrasound	$90.00	76642
Complete Abdomen Ultrasound	$126.00	76700
Real time Abdominal Ultrasound	$94.00	76705
Screening study for abdominal aortic aneurysm (AAA)	$116.00	76706
Ultrasound of abdomen complete including kidneys	$116.00	76770
Ultrasound of complete pelvic	$112.00	76856
Scrotum ultrasound	$107.00	76870
Ultrasound of tendon or a muscle	$59.00	76882
In office urinalysis	$3.00	81002
In office urine pregnancy test	$3.00	81025
In office blood sugar test	$3.00	82962
Skin injection to test for tuberculosis	$6.00	86580
In office blood test for Mono	$12.00	87449
COVID-19 infectious agent antigen detection by immunoassay (quick test)	$36.00	87426
COVID-19/Flu-A/Flu-B infectious agent antigen detection by immunoassay (quick test)	$64.00	87428
In office Strep Swab	$12.00	87880
Pediatric injection administered (given)	$29.00	90460
Additional pediatric injection administered	$20.00	90461
Additional Immunization injections administered	$20.00	90472
Hepatitis A vaccine injection for pediatric and adolescent	$35.00	90633
Hepatitis A and B Vaccine Adult	$113.00	90636
HIB Vaccine	$12.00	90648
Gardasil or HPV vaccine for ages 9 to 26	$161.00	90649
Gardasil Vaccine	$254.00	90651
Flu Shot for patients 3 years old and older	$20.00	90656
Flu shot for pediatric patient age 6 months to 35 months old	$7.00	90657
High Dose Flu Vaccine for patients over 65 years old	$66.00	90662
Pneumonia Vaccine in vial	$212.00	90670
Rotavirus vaccine	$91.00	90680
Dtap vaccine for ages 6 and younger	$27.00	90700
MMR Vaccine Injection	$88.00	90707
IPV Vaccine Injection	$39.00	90713
Tetanus and Whooping Cough Vaccine Injection	$37.00	90715
Chickenpox Vaccine Injection	$151.00	90716
Pediarix Vaccine Injection	$91.00	90723
Pneumonia Vaccine Injection	$118.00	90732
Menactra Vaccine Injection	$141.00	90734
Hepatitis B Pediatric Dose or Adult Dose	$26.00	90744
Hepatitis B Vaccine for Adult Injection	$62.00	90746
Shingles Vaccine Injection	$162.00	90750
Complete EKG	$20.00	93000
EKG recorded and reviewed	$229.00	93268
Complete echocardiogram with doppler	$242.00	93306
Ambulatory Blood Pressure Monitoring	$62.00	93784
Carotid Ultrasound	$230.00	93880
Cerebrovascular Arterial Ultrasound	$319.00	93890
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries	$98.00	93922
Complete bilateral noninvasive physiologic studies of extremity arteries, 3 or more levels	$152.00	93923
Noninvasive physiologic studies of lower extremity arteries	$188.00	93924
Noninvasive physiologic studies of lower extremity arteries	$291.00	93925
Duplex scan of extremity veins; complete bilateral study	$224.00	93970
Duplex scan of extremity veins; unilateral or limited study	$140.00	93971
Evaluation of arterial inflow and venous outflow of abdomen and/or pelvic organs	$319.00	93975
Duplex scan of aorta	$217.00	93978
Lower extremity ultrasound with doppler	$140.00	93979
In office test used to assess how well your lungs work to diagnosis asthma and COPD	$41.00	94010
Nebulizer treatment in office	$26.00	94640
Pulse Oxygen	$4.00	94760
Glucose monitor for continuous	$44.00	95251
Brief emotional or behavioral assessment	$8.00	96127
IV initial	$51.00	96360
IV add on	$21.00	96361
Injection	$29.00	96373
After hours call/consult after 10PM	$28.00	99050
Screening Vision Test	$4.00	99173
New Patient Office Visit Level 2	$103.00	99202
New Patient Office Visit Level 3	$146.00	99203
New Patient Office Visit Level 4	$225.00	99204
Established Patient Office Visit Level 1	$31.00	99211
Established Patient Office Visit Level 2	$66.00	99212
Established Patient Office Visit Level 5	$215.00	99215
New Patient Preventive Care for Age 1-4 years old	$158.00	99382
New Patient Preventive Care for Age 5-11 years old	$164.00	99383
New Patient Preventive Care for Age 12-17 years old	$186.00	99384
New Patient Preventive Care for Age 18 -39 years old	$180.00	99385
New Patient Preventive Care for Age 40 - 64 years old	$165.00	99386
Established Patient Preventive Care for less than 1 year old	$111.00	99391
Established Patient Preventive Care for Age 1-4 years old	$119.00	99392
Established Patient Preventive Care for Age 5-11 years old	$119.00	99393
Established Patient Preventive Care for Age 12-17 years old	$130.00	99394
Established Patient Preventive Care for Age 65 and over	$151.00	99397
Smoking and tobacco use counseling to the patient for 3-10 minutes	$21.00	99406
E-visit 5-10 minutes via portal	$15.00	99421
E-visit 11-20 minutes via portal	$30.00	99422
E-visit 21+ minutes via portal	$50.00	99423
Providing care planning to individuals with cognitive impairment	$355.00	99483
First 60 minutes of non-face-to-face care by clinical staff for complex chonic care	$127.00	99487
Additional 30 minutes of non-face-to-face care by clinical staff for complex chronic care	$67.00	99489
Chronic Care Management (Medicare program) Provider Call	$88.00	99491
Transition of Care Management Communication within 14 days of discharge	$251.00	99495
Transition of Care Management Communication within 7 days of discharge	$332.00	99496
Advanced Care Plan	$119.00	99497
Administration of Flu Vaccine	$29.00	G0008
Administration of Pneumonia Vaccine	$29.00	G0009
Administration of Hepatitis B Vaccine	$29.00	G0010
Diabetes self-management training services, group session (2 or more), per 30 minutes	$25.00	G0109
Physician service required to document the need for a power mobility device	$15.00	G0372
Initial Preventive Examination; face-to-face visit, new CMS patient during first 12mths	$227.00	G0402
Annual Wellness Visit Initial Visit	$233.00	G0438
Annual Wellness Visit Visit	$157.00	G0439
Screening for alcohol misuse and brief behavioral counseling	$42.00	G0443
Personally performing CCM (Chronic Care Management) care planning	$64.00	G0506
Remote image submit by pt	$19.00	G2010
Brief check in by md/qhp	$23.00	G2012
Rocephin antibiotic medication injection	$1.00	J0696
Prolia (osteoporosis treatment) injection	$22.00	J0897
Testosterone medication injection	$1.00	J1071
Betamix Medication for injection	$1.00	J1100
Toradol medication injection- Nonsteroidal anti-inflammatory drug to treat pain	$1.00	J1885
Anti-nausea medication injection	$3.00	J2550
Vitamin B-12 Injection	$2.00	J3420
Saline solution for wound care cleaning	$3.00	J7030
CCM (Chronic Care Management) staff time additional 20 minutes	$47.00	99439
Diabetic Retinal Screening	$53.00	92250