478 B
478 B
| 1 | patient id | item | dispense date | count | carrier | supply_type | Billing Staff | Auth Number |
|---|---|---|---|---|---|---|---|---|
| 2 | PT-1171 | FreestyleLibre3 | 2024-11-20 | 6 | Medicare Part B | sensor | M. Jones | CGM-2026-001 |
| 3 | PT-1172 | FreestyleLibre3 | 2025-01-02 | 3 | Medicare Part B | sensor | M. Jones | CGM-2026-001 |
| 4 | PT-1173 | FSL3 | 2024-10-05 | 2 | Medicare Part B | sensor | M. Jones | CGM-2026-001 |
| 5 | PT-1174 | FreeStyle Libre 3 | 2024-12-17 | 1 | Medicare Part B | sensor | M. Jones | CGM-2026-001 |
| 6 | PT-1175 | FSL3 | 2024-12-20 | 3 | Medicare Part B | sensor | M. Jones | CGM-2026-001 |