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2008 ABC Coding Manual - Index of

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X AHP476401<br />

Goode, Johnny, B 10 21 1951 X Goode, Johnny, B<br />

1234 Main Street<br />

X<br />

1234 Main Street<br />

Anytown ME<br />

X<br />

Anytown<br />

ME<br />

12345 123 4567890 12345 123 4567890<br />

<strong>ABC</strong> codes and practitioner identifiers used in box 24D.<br />

APPROVED OMB-0938-0999 FORM CMS-1500 (08-05)<br />

<strong>2008</strong> <strong>ABC</strong> <strong>Coding</strong> <strong>Manual</strong> for Integrative Healthcare 15<br />

X<br />

X<br />

X<br />

AA1234<br />

10 21 1951<br />

Widget Manufacturing Inc<br />

<strong>ABC</strong> Health Plan<br />

SOF 01/27/2007<br />

SOF<br />

01 07 2007 09 23 2001 01 04 2007 01 08 2007<br />

Integrative Healthcare Center<br />

123456789<br />

0123456789<br />

784 0<br />

780 6<br />

01 07 07<br />

01 07 07<br />

987654321 X GOODE001 X<br />

130 00 15 00 115 00<br />

Phil Smith, DOM 01/10/2007<br />

X<br />

X<br />

X<br />

100 00<br />

123456789<br />

11 N ACBAE 1C 123 40 00 1 Y 0123456789<br />

123456789<br />

11 N CACAB<br />

1C 12 90 00 2 Y 0123456789<br />

Integrative Healthcare Center<br />

6677 Med Park Lane<br />

Anytown, ME 12347<br />

123 5301234<br />

Integrative Healthcare Center<br />

6677 Med Park Lane<br />

Anytown, ME 12347<br />

0123456789 A1A012468<br />

0123456789 A1A012468

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