{
    "reporting_entity_name": "NOITU INSURANCE TRUST FUND",
    "reporting_entity_type": "GROUP HEALTH INSURANCE",
    "last_updated_on": "2026-10-15",
    "version": "1.0.0",
    "out_of_network":[
    { "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "2022",
    "billing_code": "0915",
    "description": "Behavioral Health Treatments/Services Extension of 090X - Group therapy ",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "364844689"
       },
      "service_code": ["89"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 23.05,
        "providers": [{
          "billed_charge": 3125.00,
          "npi": [1700328283]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "80307",
    "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTRUMENT CHEMISTRY ANALYZERS (EG, UTILIZING IMMUNOASSAY [EG, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), CHROMATOGRAPHY (EG, GC, HPLC), AND MASS SPECTROMETRY EITHER WITH OR WITHOUT CHROMATOGRAPHY, (EG, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) INCLUDES SAMPLE VALIDATION WHEN PERFORMED, PER DATE OF SERVICE",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "465330784"
      },
      "service_code": ["81"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 75.00,
        "providers": [{
          "billed_charge": 75.00,
          "npi": []
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "90832",
    "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "131656681"
      },
      "service_code": ["02"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 119.36,
        "providers": [{
          "billed_charge": 119.36,
          "npi": []
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "131656681"
      },
      "service_code": ["02"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 129.51,
        "providers": [{
          "billed_charge": 129.51,
          "npi": []
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "90834",
    "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "921597475"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 142.51,
        "providers": [{
          "billed_charge": 350.00,
          "npi": [1225439219]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "90837",
    "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "129442223"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 211.27,
        "providers": [{
          "billed_charge": 425.00,
          "npi": [1205859337]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "271620688"
      },
      "service_code": ["10", "11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 257.10,
        "providers": [{
          "billed_charge": 385.00,
          "npi": [1205200979,1912534439,1932521531]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "97032",
    "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "834525038"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 24.19,
        "providers": [{
          "billed_charge": 90.00,
          "npi": [1235889254]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "97110",
    "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "205243343"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 48.99,
        "providers": [{
          "billed_charge": 198.00,
          "npi": [1790197507]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "843635203"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 40.51,
        "providers": [{
          "billed_charge": 120.00,
          "npi": [1386113819]
        },{
          "billed_charge": 240.00,
          "npi": [1386113819]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "933506889"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 40.51,
        "providers": [{
          "billed_charge": 200.00,
          "npi": [1922646793]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "834525038"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 48.99,
        "providers": [{
          "billed_charge": 140.00,
          "npi": [1235889254]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "921968797"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 48.99,
        "providers": [{
          "billed_charge": 140.00,
          "npi": [1003546540]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "97112",
    "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE, COORDINATION, KINESTHETIC SENSE, POSTURE, AND/OR PROPRIOCEPTION FOR SITTING AND/OR STANDING ACTIVITIES",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "834525038"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 54.46,
        "providers": [{
          "billed_charge": 135.00,
          "npi": [1235889254]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "933506889"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 45.03,
        "providers": [{
          "billed_charge": 200.00,
          "npi": [1922646793]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "921968797"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 54.46,
        "providers": [{
          "billed_charge": 140.00,
          "npi": [1003546540]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "97140",
    "description": "MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTION), 1 OR MORE REGIONS, EACH 15 MINUTES",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "834525038"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 46.23,
        "providers": [{
          "billed_charge": 130.00,
          "npi": [1235889254]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "843635203"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 38.21,
        "providers": [{
          "billed_charge": 120.00,
          "npi": [1386113819]
        },{
          "billed_charge": 240.00,
          "npi": [1386113819]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "921968797"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 46.23,
        "providers": [{
          "billed_charge": 140.00,
          "npi": [1003546540]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "97530",
    "description": "THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "933506889"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 49.18,
        "providers": [{
          "billed_charge": 100.00,
          "npi": [1922646793]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "921968797"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 59.35,
        "providers": [{
          "billed_charge": 140.00,
          "npi": [1003546540]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "98940",
    "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "461346580"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 44.92,
        "providers": [{
          "billed_charge": 130.00,
          "npi": [1164535290]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "474749096"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 44.92,
        "providers": [{
          "billed_charge": 182.00,
          "npi": [1740046325,1750980959]
        }]
      }]
    },{
      "tin": {
        "type": "ein",
        "value": "912055703"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 37.09,
        "providers": [{
          "billed_charge": 70.00,
          "npi": [1477622611]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "98943",
    "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "474749096"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 42.53,
        "providers": [{
          "billed_charge": 183.00,
          "npi": [1740046325,1750980959]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "CPT",
    "billing_code_type_version": "CPT 2026",
    "billing_code": "99233",
    "description": "SUBSEQUENT HOSPITAL INPATIENT OR OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND HIGH LEVEL OF MEDICAL DECISION MAKING. WHEN USING TOTAL TIME ON THE DATE OF THE ENCOUNTER FOR CODE SELECTION, 50 MINUTES MUST BE MET OR EXCEEDED.",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "300537029"
      },
      "service_code": ["21"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 116.98,
        "providers": [{
          "billed_charge": 500.00,
          "npi": [1023768892,1134721533]
        }]
      }]
    }]
  },{
    "name": "Established Patient Office or Other Outpatient Services",
    "billing_code_type": "HCPCS",
    "billing_code_type_version": "HCPCS 2026 Q1",
    "billing_code": "G0283",
    "description": "Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",
    "allowed_amounts": [{
      "tin": {
        "type": "ein",
        "value": "843635203"
      },
      "service_code": ["11"],
      "billing_class": "PROFESSIONAL",
      "payments": [{
        "allowed_amount": 17.51,
        "providers": [{
          "billed_charge": 100.00,
          "npi": [1386113819]
        }]
      }]
    }]
  }]
}
