| Calculated Level of Service |
| Type of Service |
-- |
| Type of Visit |
-- |
| Service Provided |
-- |
| Number and Complexity of Problems Addressed |
|
| Amount and/or Complexity of Data to be Reviewed and Analyzed |
|
| Risk of Complications and/or Morbidity or Mortality of Patient Management |
|
| Medical Decision Making |
|
| Total Face -to-Face Time ( in min.) |
|