| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,940 |
4,434 |
$3.94M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
42,929 |
41,588 |
$3.01M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,667 |
5,607 |
$1.11M |
| E0601 |
Continuous positive airway pressure (cpap) device |
23,884 |
23,602 |
$997K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
8,000 |
7,808 |
$911K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
5,565 |
5,555 |
$691K |
| E1399 |
Durable medical equipment, miscellaneous |
1,371 |
1,272 |
$678K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,745 |
3,323 |
$593K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
852 |
832 |
$513K |
| E0570 |
Nebulizer, with compressor |
11,741 |
11,412 |
$478K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,676 |
1,644 |
$395K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
4,956 |
4,827 |
$387K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
23,914 |
23,735 |
$382K |
| K0003 |
Lightweight wheelchair |
9,512 |
9,438 |
$346K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,418 |
2,272 |
$345K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,465 |
7,397 |
$283K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,801 |
4,671 |
$262K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,506 |
3,385 |
$258K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,430 |
2,359 |
$241K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
7,567 |
4,080 |
$233K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,923 |
3,888 |
$171K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
782 |
772 |
$148K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,247 |
4,102 |
$141K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
859 |
851 |
$134K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
625 |
619 |
$130K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,028 |
1,996 |
$121K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
10,072 |
9,983 |
$116K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
987 |
926 |
$115K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,318 |
2,166 |
$114K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
7,053 |
6,947 |
$104K |
| A7037 |
Tubing used with positive airway pressure device |
5,938 |
5,742 |
$102K |
| A7035 |
Headgear used with positive airway pressure device |
7,084 |
6,767 |
$100K |
| K0004 |
High strength, lightweight wheelchair |
1,470 |
1,466 |
$97K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
784 |
735 |
$94K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
740 |
697 |
$87K |
| S8189 |
Tracheostomy supply, not otherwise classified |
490 |
461 |
$81K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,530 |
2,118 |
$80K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,265 |
2,964 |
$79K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
851 |
778 |
$79K |
| B4100 |
Food thickener, administered orally, per ounce |
545 |
505 |
$77K |
| A4670 |
Automatic blood pressure monitor |
1,618 |
1,613 |
$77K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
199 |
188 |
$76K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,391 |
2,329 |
$71K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,440 |
1,357 |
$64K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,290 |
1,219 |
$61K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,911 |
1,536 |
$59K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,142 |
1,102 |
$59K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,752 |
1,746 |
$58K |
| K0001 |
Standard wheelchair |
4,213 |
4,191 |
$54K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
355 |
353 |
$52K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
997 |
949 |
$51K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,104 |
1,052 |
$48K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
809 |
775 |
$46K |
| E0784 |
External ambulatory infusion pump, insulin |
18 |
17 |
$46K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
377 |
348 |
$45K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,758 |
8,294 |
$44K |
| A4927 |
Gloves, non-sterile, per 100 |
2,128 |
2,048 |
$41K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
940 |
933 |
$40K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
335 |
322 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,346 |
1,204 |
$33K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
274 |
263 |
$31K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,438 |
1,389 |
$31K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
202 |
191 |
$30K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
865 |
849 |
$29K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
676 |
643 |
$28K |
| E0156 |
Seat attachment, walker |
2,977 |
2,952 |
$25K |
| K0007 |
Extra heavy duty wheelchair |
535 |
535 |
$25K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
352 |
344 |
$25K |
| E0619 |
Apnea monitor, with recording feature |
146 |
139 |
$25K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
92 |
92 |
$24K |
| T4541 |
Incontinence product, disposable underpad, large, each |
821 |
788 |
$23K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,276 |
3,225 |
$23K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
163 |
105 |
$22K |
| S5199 |
Personal care item, nos, each |
1,386 |
1,326 |
$22K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,050 |
909 |
$22K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
297 |
291 |
$22K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
861 |
858 |
$20K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,096 |
2,082 |
$19K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,367 |
1,177 |
$17K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
355 |
341 |
$16K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,221 |
3,164 |
$15K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
215 |
113 |
$15K |
| E0776 |
Iv pole |
1,735 |
1,723 |
$12K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
160 |
158 |
$12K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
197 |
195 |
$11K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,581 |
1,542 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
9,749 |
9,563 |
$11K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
169 |
166 |
$11K |
| E0607 |
Home blood glucose monitor |
313 |
310 |
$10K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
611 |
609 |
$9K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
305 |
305 |
$9K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
125 |
94 |
$9K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
103 |
101 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,311 |
1,196 |
$8K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
243 |
233 |
$8K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
261 |
255 |
$7K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
117 |
112 |
$7K |
| A4259 |
Lancets, per box of 100 |
1,857 |
1,823 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
1,054 |
1,036 |
$6K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
396 |
370 |
$6K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
103 |
82 |
$5K |
| E1020 |
Residual limb support system for wheelchair, any type |
331 |
298 |
$5K |
| B4082 |
Nasogastric tubing without stylet |
165 |
156 |
$5K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
25 |
25 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
933 |
882 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
227 |
223 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
828 |
784 |
$4K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
309 |
288 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,576 |
4,474 |
$4K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
199 |
199 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
430 |
385 |
$3K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
37 |
36 |
$3K |
| A4623 |
Tracheostomy, inner cannula |
54 |
50 |
$2K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
46 |
38 |
$2K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,870 |
2,764 |
$2K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
34 |
34 |
$2K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
79 |
75 |
$2K |
| E2209 |
Accessory, arm trough, with or without hand support, each |
171 |
170 |
$2K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
12 |
12 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
163 |
157 |
$1K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
32 |
31 |
$1K |
| A4256 |
Normal, low and high calibrator solution / chips |
327 |
327 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
67 |
64 |
$1K |
| A4322 |
Irrigation syringe, bulb or piston, each |
111 |
99 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
12 |
12 |
$1K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
147 |
147 |
$961.98 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
172 |
169 |
$815.56 |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
25 |
25 |
$804.25 |
| A4402 |
Lubricant, per ounce |
540 |
530 |
$617.73 |
| A4371 |
Ostomy skin barrier, powder, per oz |
104 |
102 |
$566.53 |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
15 |
13 |
$416.09 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
38 |
37 |
$365.34 |
| A4258 |
Spring-powered device for lancet, each |
68 |
68 |
$232.12 |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
24 |
24 |
$184.07 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
16 |
12 |
$167.01 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
14 |
14 |
$127.09 |
| K0053 |
Elevating footrests, articulating (telescoping), each |
15 |
12 |
$106.48 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
16 |
15 |
$87.92 |
| A7012 |
Water collection device, used with large volume nebulizer |
12 |
12 |
$46.52 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$6.22 |