| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,269 |
1,184 |
$1.44M |
| E0601 |
Continuous positive airway pressure (cpap) device |
22,773 |
20,362 |
$1.21M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,753 |
13,092 |
$1.03M |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
10,622 |
9,370 |
$989K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
9,402 |
8,495 |
$625K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,254 |
3,355 |
$528K |
| 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) |
1,468 |
1,406 |
$474K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
26,943 |
24,110 |
$460K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,533 |
3,029 |
$379K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,767 |
3,361 |
$330K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,580 |
3,805 |
$288K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,434 |
2,122 |
$274K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,954 |
1,805 |
$256K |
| K0001 |
Standard wheelchair |
7,519 |
6,851 |
$224K |
| 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) |
2,565 |
2,348 |
$199K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,042 |
1,921 |
$185K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,359 |
8,423 |
$153K |
| A7035 |
Headgear used with positive airway pressure device |
7,719 |
6,542 |
$150K |
| A7037 |
Tubing used with positive airway pressure device |
7,945 |
6,730 |
$148K |
| 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 |
444 |
386 |
$106K |
| E1392 |
Portable oxygen concentrator, rental |
41 |
40 |
$102K |
| 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 |
275 |
241 |
$100K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,112 |
1,066 |
$92K |
| 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 |
839 |
701 |
$91K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
699 |
635 |
$89K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,998 |
1,792 |
$61K |
| 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 |
63 |
48 |
$59K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
865 |
680 |
$56K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,127 |
4,344 |
$49K |
| E1399 |
Durable medical equipment, miscellaneous |
525 |
398 |
$48K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,748 |
3,463 |
$46K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
6,900 |
5,871 |
$45K |
| E0776 |
Iv pole |
3,752 |
3,352 |
$43K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
1,088 |
1,047 |
$43K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,645 |
1,579 |
$31K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
445 |
287 |
$30K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
369 |
329 |
$29K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
466 |
453 |
$26K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
543 |
463 |
$23K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,807 |
1,561 |
$18K |
| 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 |
91 |
91 |
$17K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,924 |
1,749 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
176 |
167 |
$13K |
| K0006 |
Heavy duty wheelchair |
121 |
120 |
$12K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
215 |
201 |
$10K |
| E0441 |
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
191 |
116 |
$7K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
41 |
36 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
1,567 |
1,491 |
$5K |
| A7504 |
Filter for use in a tracheostoma heat and moisture exchange system, each |
186 |
175 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
38 |
38 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
205 |
199 |
$2K |
| E0607 |
Home blood glucose monitor |
25 |
25 |
$2K |
| E0156 |
Seat attachment, walker |
24 |
24 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
25 |
24 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
23 |
14 |
$1K |
| A4618 |
Breathing circuits |
109 |
101 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
77 |
76 |
$602.42 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
110 |
108 |
$506.52 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
12 |
12 |
$180.72 |
| A4259 |
Lancets, per box of 100 |
204 |
199 |
$145.52 |