Empowering the Patient

Specifics regarding the care we give at this clinic and how to speak with your insurance company about the common codes we use, possible authorization requirements, referrals needed and etc. This is broken down by the type of care one is receiving, if you receive multiple modalities you will need to ask about each one. Below we have added our tax ID and Group NPI, the insurance representative you speak to may want this information to ensure they can get as accurate of answers as they can for you.

For appointments before 1/1/25 use:
Tabor Sun Tax ID: 32-0181185 Group NPI: 172 054 2749
For appointments after 1/1/25 use:
MIJO Tax ID: 99-4145263 Group NPI: 159 859 1331

We understand you might be looking for care from a specific provider, however, we HIGHLY encourage you to ask for BENEFITS COVERED rather than if a provider is in network. Our providers are in-network with many panels. Yet you can be told the provider is in-network, but the services offered are NOT covered.

Acupuncture:
Office Visit Codes

• 99203: New patient detailed exam
  First appointments or if it’s been >3years since your last appointment.
• 99212, 99213: Existing patient exam
  Use for new injury, an injury that needs a re-evaluation or if it has been between 1 and 3 years since your last visit Procedure Codes
• 97810: Acupuncture use of one or more needles – 15 minutes
• 97811: 15 minutes more of acupuncture
• 97026 (PT code): Use of infrared light
• 97140 (PT code): Manual therapy, cupping
  If you have a MODA plan, make sure to ask if “Medical Necessity Review” is required from the beginning or after a certain number of visits.
  Some other insurance companies may require prior authorization for acupuncture as well, so ask if any of these codes require that. If so, who is it through?Remember to ask what your visit limit is.

   

  Ask the representative if physical therapy codes used by an acupuncturist go towards your physical therapy visit limit.

  Ask if a referral is required, if so, who can write you one?

Massage:

• 97124 (PT code): 15-minute massage code

Oftentimes plans will say you have massage coverage, but it will only be covered by a chiropractor or physical therapist. Ask your representative if you have massage coverage when performed by a licensed massage therapist.We do not provide massage therapy “in conjunction” with chiropractic or physical therapy. Our licensed massage therapists are practicing under the scope of their license, which does not include chiro or PT.

We do 60-minute and 90-minute massages at our clinic, ask the representative if there is a limit to the amount of time billed to insurance. Most insurance companies only allow 60 minutes to be billed.

Ask if a referral is required, if so, who can write you one?

If you have BCBS through Intel and your member ID starts with ILY you must get a referral for massage and it needs to contain the frequency of care, the total length of care (Ex: 1 massage per week for 8 weeks), our clinic name, and the providers NPI and Tax ID. The individual NPI’s are listed later in this document, the Tax ID is on the second page of this document.

Ask the representative if physical therapy codes used by a massage therapist go towards your physical therapy visit limit.

Important things for specific insurance companies:

Medicare Advantage plans

If you have any of the Medicare Advantage plans, ask if there are limitations for diagnosis, services received, or visit limits. For example, generally only spinal manipulation for subluxation of the spine is covered when seeing a chiropractor and when seeing an acupuncturist, only acupuncture for low back pain is covered.

We are not contracted with Medicare. Some plans will consider us to be out-of-network because of this. We are out-of-network with any Medicare Advantage plans that utilize the American Specialty Health Network (ASHN).

Cigna

We are out of network for acupuncture and massage. If you are looking to receive this kind of care and you have Cigna, ask the representative if you have out of network benefits – you might still be able to use your benefits.

Providence

Ask if you need prior authorization for chiropractic, acupuncture, and physical therapy. Give them all the codes listed under these specialties for them to check. If they say you need prior authorization, ask who it will be through; it will most likely be through Evicore.

Kaiser

We are out of network for massage and naturopathic care.

Ask if you have physician-referred or self-referred benefits. If you only have physician-referred benefits, you will need to obtain a referral for the services we provide here.

United Health Care

We are out of network for chiropractic care and massage. If you are looking to receive this kind of care and you have UHC, ask the representative if you have out of network benefits – you might still be able to use your benefits.

Aetna

We are out of network for massage. If you are looking to receive this kind of care and you have Aetna, ask the representative if you have out of network benefits – you might still be able to use your benefits.

Regence BCBS

Blue Cross Blue Shield is a national company; Regence is the local plan. If you have an out-of-state plan (ex: Anthem or Primera), your representative may ask if we are in network with the local plan; we are.

 We are out of network for all services for plans that have a three-letter prefix of “O2F”. Ask the representative if you have out of network benefits – you might still be able to use your benefits

Ask if you need prior authorization for chiropractic, acupuncture, and physical therapy. Give them all the codes listed under these specialties for them to check. If they say you need prior authorization, ask who it will be through; it will most likely be through Evicore.

MODA

MODA has several networks – Connexus, Synergy, OHSU, and others.

If you want to come here for a massage, ask if you have massage benefits from a licensed massage therapist. If you have an OHSU MODA plan, you can only receive massage at an OHSU facility.

Ask the representative if medical necessity review for any services you receive here is required and if so, after how many visits.

Ask if you need prior authorization for chiropractic, acupuncture, and physical therapy. Give them all the codes listed under these specialties for them to check. If they say you need prior authorization, ask who it will be through; it will most likely be through Evicore.

OHP (Oregon Health Plan)

We are out of network with this plan for all services. If you would like to come here for services, you will have to sign a form waiving OHP from paying anything towards your visit. This is also applicable if OHP is your secondary insurance.

NPI’s

Dr. Cruz: 191-295-1682 Sharon: 174-023-4103 Shao Lun “James” Ho: 105-304-4032
Dr. Fuegy: 136-645-1973 Brittany: 174-050-8332 Sarah: 142-720-9220
Dr. Vance: 140-711-9605 Jonathan: 169-921-7828 Dr. Young: 145-778-9661
Orion: 176-076-0912

For patients with Kaiser insurance:

Ins rep name: ____________ Date: ______________ Reference Number: _______________

For patients with all other insurances:

Ins rep name: ____________ Date: ______________ Reference Number: ________________

Chiropractic: Max Visits _________ Remain: _________ Combined w/: ____________________________

Acupuncture: Max Visits _________ Remain: _________ Combined w/: ____________________________

Naturopath: Max Visits _________ Remain: _________ Combined w/: ____________________________

Massage: Max Visits: __________ Remain:_________ Combined with: _____________________________