| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
980 |
910 |
$302K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
930 |
815 |
$148K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,563 |
1,447 |
$127K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,344 |
1,260 |
$125K |
| 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) |
248 |
243 |
$102K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
113 |
109 |
$85K |
| E0601 |
Continuous positive airway pressure (cpap) device |
833 |
827 |
$64K |
| 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 |
281 |
256 |
$57K |
| 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 |
296 |
278 |
$49K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
468 |
417 |
$35K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
888 |
775 |
$32K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
670 |
618 |
$25K |
| A4245 |
Alcohol wipes, per box |
548 |
521 |
$21K |
| A4217 |
Sterile water/saline, 500 ml |
203 |
155 |
$18K |
| A4215 |
Needle, sterile, any size, each |
274 |
240 |
$15K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
168 |
129 |
$15K |
| A7526 |
Tracheostomy tube collar/holder, each |
306 |
275 |
$12K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
373 |
352 |
$11K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
337 |
317 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
273 |
258 |
$10K |
| A7002 |
Tubing, used with suction pump, each |
409 |
372 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
495 |
452 |
$7K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
366 |
329 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
428 |
371 |
$5K |
| A4259 |
Lancets, per box of 100 |
334 |
317 |
$4K |
| E0776 |
Iv pole |
347 |
310 |
$4K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
105 |
98 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
297 |
295 |
$3K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
154 |
140 |
$3K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
14 |
13 |
$2K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
62 |
62 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
75 |
72 |
$1K |
| S8490 |
Insulin syringes (100 syringes, any size) |
12 |
12 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
125 |
118 |
$977.50 |
| A4332 |
Lubricant, individual sterile packet, each |
141 |
121 |
$861.81 |
| A4244 |
Alcohol or peroxide, per pint |
93 |
80 |
$503.30 |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
43 |
42 |
$247.84 |
| A4452 |
Tape, waterproof, per 18 square inches |
31 |
29 |
$128.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
78 |
78 |
$37.87 |