| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
15,850 |
12,888 |
$8.51M |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
19,973 |
13,521 |
$7.93M |
| 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 |
11,606 |
9,811 |
$1.79M |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,327 |
2,031 |
$1.61M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,048 |
8,448 |
$1.40M |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
5,044 |
3,859 |
$1.21M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
7,701 |
7,635 |
$820K |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
1,874 |
1,404 |
$626K |
| 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 |
2,279 |
1,907 |
$365K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,014 |
3,971 |
$352K |
| 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 |
2,324 |
1,928 |
$342K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
7,009 |
5,662 |
$292K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,805 |
3,741 |
$148K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
595 |
463 |
$113K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
287 |
277 |
$113K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,064 |
1,015 |
$88K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,445 |
1,441 |
$86K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,292 |
956 |
$65K |
| S9338 |
Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
962 |
298 |
$63K |
| 99601 |
|
574 |
229 |
$56K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,060 |
1,014 |
$50K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,102 |
2,094 |
$44K |
| E0570 |
Nebulizer, with compressor |
1,777 |
1,753 |
$43K |
| B9002 |
Enteral nutrition infusion pump, any type |
60 |
58 |
$31K |
| S9341 |
Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
121 |
62 |
$29K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,444 |
1,426 |
$26K |
| A7035 |
Headgear used with positive airway pressure device |
1,692 |
1,687 |
$21K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
506 |
505 |
$15K |
| A7037 |
Tubing used with positive airway pressure device |
1,044 |
1,044 |
$11K |
| B4082 |
Nasogastric tubing without stylet |
406 |
305 |
$11K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
742 |
740 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,122 |
4,096 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
414 |
414 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
237 |
230 |
$5K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
127 |
118 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
452 |
449 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
121 |
121 |
$418.19 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
104 |
103 |
$213.49 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$204.19 |
| A4245 |
Alcohol wipes, per box |
13 |
12 |
$21.63 |