| 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 |
9,111 |
8,225 |
$6.66M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
27,098 |
22,701 |
$6.66M |
| B9998 |
Noc for enteral supplies |
40,199 |
27,332 |
$4.08M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
5,529 |
5,083 |
$3.98M |
| 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 |
11,109 |
9,907 |
$3.32M |
| 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 |
5,732 |
5,055 |
$2.26M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,018 |
2,927 |
$2.13M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18,710 |
18,133 |
$2.08M |
| 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 |
2,132 |
1,323 |
$1.58M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
22,363 |
11,169 |
$1.47M |
| 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 |
5,468 |
4,848 |
$1.27M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
4,819 |
4,641 |
$1.17M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
5,957 |
5,763 |
$1.11M |
| B9002 |
Enteral nutrition infusion pump, any type |
7,365 |
7,181 |
$823K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
6,386 |
5,630 |
$696K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,962 |
3,872 |
$693K |
| A4605 |
Tracheal suction catheter, closed system, each |
4,826 |
3,850 |
$666K |
| 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 |
1,448 |
1,155 |
$661K |
| 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 |
3,101 |
2,453 |
$605K |
| A7000 |
Canister, disposable, used with suction pump, each |
19,787 |
15,773 |
$588K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
6,690 |
6,098 |
$587K |
| 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) |
1,833 |
1,771 |
$570K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
993 |
820 |
$504K |
| 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 |
2,269 |
2,026 |
$484K |
| A4554 |
Disposable underpads, all sizes |
15,067 |
13,809 |
$464K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,731 |
4,772 |
$453K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
2,845 |
2,745 |
$384K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,431 |
4,783 |
$363K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,845 |
17,367 |
$345K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,666 |
2,309 |
$339K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,261 |
3,055 |
$327K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,123 |
4,737 |
$276K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,783 |
2,332 |
$266K |
| A7526 |
Tracheostomy tube collar/holder, each |
9,469 |
7,235 |
$264K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,011 |
1,715 |
$250K |
| 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 |
1,036 |
893 |
$249K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,698 |
2,371 |
$236K |
| A7002 |
Tubing, used with suction pump, each |
22,008 |
16,449 |
$228K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,099 |
1,822 |
$213K |
| A4322 |
Irrigation syringe, bulb or piston, each |
21,399 |
19,356 |
$193K |
| E1399 |
Durable medical equipment, miscellaneous |
483 |
443 |
$169K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,664 |
2,600 |
$150K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
33,785 |
21,941 |
$148K |
| 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) |
920 |
869 |
$145K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,398 |
1,294 |
$131K |
| A4335 |
Incontinence supply; miscellaneous |
19,734 |
17,983 |
$130K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
10,135 |
6,603 |
$118K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
769 |
687 |
$108K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
151 |
142 |
$105K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
18,158 |
15,295 |
$102K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
836 |
749 |
$100K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
4,399 |
3,234 |
$98K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12,213 |
11,044 |
$87K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
514 |
454 |
$86K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
3,491 |
3,193 |
$82K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
768 |
734 |
$79K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
595 |
547 |
$74K |
| A6210 |
Foam 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 |
275 |
193 |
$64K |
| E0776 |
Iv pole |
6,766 |
6,582 |
$55K |
| A4452 |
Tape, waterproof, per 18 square inches |
7,624 |
6,867 |
$53K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
295 |
293 |
$47K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,010 |
968 |
$46K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,417 |
1,386 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
6,794 |
5,607 |
$43K |
| A4217 |
Sterile water/saline, 500 ml |
1,871 |
1,407 |
$42K |
| B4100 |
Food thickener, administered orally, per ounce |
1,347 |
1,259 |
$38K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14,193 |
13,481 |
$36K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,888 |
1,349 |
$34K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
202 |
194 |
$31K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
735 |
476 |
$30K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
1,642 |
1,560 |
$30K |
| E0570 |
Nebulizer, with compressor |
294 |
288 |
$29K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,576 |
1,409 |
$27K |
| A4623 |
Tracheostomy, inner cannula |
574 |
512 |
$26K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
470 |
455 |
$24K |
| A4402 |
Lubricant, per ounce |
4,485 |
4,328 |
$22K |
| A4481 |
Tracheostoma filter, any type, any size, each |
2,408 |
1,698 |
$22K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
203 |
156 |
$16K |
| B4082 |
Nasogastric tubing without stylet |
294 |
245 |
$16K |
| E0300 |
Pediatric crib, hospital grade, fully enclosed, with or without top enclosure |
94 |
91 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
964 |
875 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
151 |
147 |
$14K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
567 |
503 |
$13K |
| K0001 |
Standard wheelchair |
402 |
389 |
$13K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
108 |
75 |
$12K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,710 |
1,508 |
$11K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,409 |
1,277 |
$11K |
| A7525 |
Tracheostomy mask, each |
3,921 |
3,641 |
$11K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
1,166 |
712 |
$9K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,649 |
1,598 |
$7K |
| A4670 |
Automatic blood pressure monitor |
129 |
128 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,739 |
4,241 |
$5K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
44 |
39 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
423 |
387 |
$5K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,470 |
1,335 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
181 |
168 |
$4K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
24 |
12 |
$4K |
| A4371 |
Ostomy skin barrier, powder, per oz |
588 |
557 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,439 |
1,223 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
622 |
591 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
186 |
179 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
75 |
49 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
108 |
101 |
$2K |
| S8999 |
Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
14 |
14 |
$2K |
| A4245 |
Alcohol wipes, per box |
770 |
722 |
$1K |
| A4456 |
Adhesive remover, wipes, any type, each |
113 |
86 |
$945.97 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
121 |
114 |
$935.37 |
| L8501 |
Tracheostomy speaking valve |
17 |
14 |
$897.52 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
79 |
78 |
$835.54 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
51 |
50 |
$744.74 |
| A4657 |
Syringe, with or without needle, each |
372 |
291 |
$571.59 |
| A4244 |
Alcohol or peroxide, per pint |
723 |
702 |
$406.65 |
| A4332 |
Lubricant, individual sterile packet, each |
128 |
116 |
$400.39 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
458 |
450 |
$289.05 |
| A4649 |
Surgical supply; miscellaneous |
92 |
82 |
$214.75 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
26 |
25 |
$143.91 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
12 |
12 |
$34.97 |