| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,203 |
2,138 |
$1.56M |
| 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 |
1,570 |
1,497 |
$1.28M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,672 |
1,626 |
$1.26M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,808 |
3,714 |
$1.03M |
| B9998 |
Noc for enteral supplies |
6,968 |
4,749 |
$702K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,125 |
5,026 |
$567K |
| 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 |
1,569 |
1,059 |
$447K |
| 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 |
1,693 |
1,540 |
$423K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,541 |
3,373 |
$357K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,527 |
1,436 |
$338K |
| 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 |
1,257 |
1,163 |
$241K |
| A4554 |
Disposable underpads, all sizes |
6,634 |
6,355 |
$213K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,058 |
1,814 |
$157K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,405 |
1,326 |
$156K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,813 |
3,664 |
$138K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,080 |
1,045 |
$122K |
| A4605 |
Tracheal suction catheter, closed system, each |
895 |
826 |
$108K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,097 |
1,022 |
$107K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,177 |
4,004 |
$104K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,106 |
1,053 |
$100K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
851 |
737 |
$96K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,787 |
4,675 |
$93K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,438 |
1,288 |
$71K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
4,265 |
2,799 |
$67K |
| A7002 |
Tubing, used with suction pump, each |
3,915 |
3,767 |
$65K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,382 |
2,034 |
$60K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
538 |
522 |
$53K |
| 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 |
214 |
212 |
$48K |
| E0601 |
Continuous positive airway pressure (cpap) device |
725 |
671 |
$46K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,945 |
1,706 |
$44K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
337 |
305 |
$43K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,078 |
4,020 |
$40K |
| A4335 |
Incontinence supply; miscellaneous |
7,871 |
7,470 |
$39K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
370 |
351 |
$38K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
777 |
682 |
$38K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,929 |
1,786 |
$29K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
6,704 |
3,745 |
$26K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
159 |
156 |
$23K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
385 |
339 |
$22K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
858 |
839 |
$22K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
4,343 |
3,920 |
$20K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,028 |
4,914 |
$17K |
| 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) |
93 |
92 |
$16K |
| A7030 |
Full face mask used with positive airway pressure device, each |
143 |
142 |
$15K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
168 |
158 |
$12K |
| B9002 |
Enteral nutrition infusion pump, any type |
124 |
117 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
317 |
301 |
$9K |
| A4402 |
Lubricant, per ounce |
1,819 |
1,628 |
$8K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
64 |
61 |
$8K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
12 |
12 |
$8K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
840 |
810 |
$7K |
| A4927 |
Gloves, non-sterile, per 100 |
905 |
875 |
$6K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,092 |
878 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
50 |
50 |
$6K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
191 |
183 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,531 |
3,488 |
$4K |
| A7525 |
Tracheostomy mask, each |
1,277 |
1,213 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,413 |
2,382 |
$4K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
3,609 |
3,518 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
138 |
137 |
$3K |
| E0776 |
Iv pole |
152 |
145 |
$2K |
| A4657 |
Syringe, with or without needle, each |
1,313 |
997 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
242 |
239 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
51 |
49 |
$939.11 |
| E0570 |
Nebulizer, with compressor |
13 |
12 |
$920.39 |
| A4452 |
Tape, waterproof, per 18 square inches |
121 |
120 |
$756.88 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
70 |
65 |
$596.68 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
13 |
13 |
$345.22 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
14 |
12 |
$52.11 |
| A4618 |
Breathing circuits |
12 |
12 |
$3.62 |
| A4616 |
Tubing (oxygen), per foot |
16 |
12 |
$2.48 |