Rise N Shine Hypnosis and Counseling Super Bill
LPC-16270 Tax ID: 20 229 2013 NPI: 159 88 34160
Client:
Diagnostic code: F41.1 Generalized Anxiety Disorder
CPT Code: _______ Date of Service: _________ Fee: _____
CPT Code: _______ Date of Service: _________ Fee: _____
CPT Code: _______ Date of Service: _________ Fee: _____
CPT Code: ______ Date of Service: _________ Fee: _____
Total payment:
90791 Initial Assessment
90837 Individual session: 60 min
90785 Interactive Complexity – add on code
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Gloria Eichenauer, Licensed Professional Counselor