| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
29,460 |
14,132 |
$3.25M |
| 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 |
21,954 |
11,363 |
$2.51M |
| 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 |
3,656 |
2,524 |
$1.78M |
| 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 |
14,972 |
8,794 |
$1.22M |
| 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 |
19,676 |
10,416 |
$1.14M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,566 |
8,244 |
$1.04M |
| B9998 |
Noc for enteral supplies |
12,281 |
6,529 |
$645K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,064 |
7,166 |
$607K |
| E0570 |
Nebulizer, with compressor |
9,658 |
9,215 |
$433K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,418 |
4,943 |
$257K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,624 |
3,245 |
$246K |
| 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) |
1,309 |
1,176 |
$244K |
| 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 |
6,891 |
3,068 |
$222K |
| A7031 |
Face mask interface, replacement for full face mask, each |
5,000 |
4,769 |
$208K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,065 |
1,985 |
$199K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
5,347 |
2,836 |
$187K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,710 |
3,129 |
$185K |
| 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 |
3,884 |
2,832 |
$159K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
8,654 |
8,065 |
$156K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,111 |
909 |
$150K |
| A7037 |
Tubing used with positive airway pressure device |
4,407 |
4,266 |
$108K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,335 |
1,273 |
$92K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,521 |
1,470 |
$86K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,333 |
9,767 |
$75K |
| A7035 |
Headgear used with positive airway pressure device |
3,228 |
3,106 |
$72K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
559 |
463 |
$54K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,070 |
1,036 |
$41K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,590 |
1,150 |
$41K |
| K0001 |
Standard wheelchair |
1,971 |
1,833 |
$41K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
603 |
577 |
$31K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
347 |
276 |
$22K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,706 |
1,597 |
$16K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,535 |
2,244 |
$16K |
| E0776 |
Iv pole |
3,676 |
3,214 |
$13K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
237 |
217 |
$12K |
| A7526 |
Tracheostomy tube collar/holder, each |
358 |
300 |
$6K |
| A7000 |
Canister, disposable, used with suction pump, each |
983 |
848 |
$5K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
111 |
79 |
$5K |
| A7036 |
Chinstrap used with positive airway pressure device |
361 |
341 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
217 |
213 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
78 |
60 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
126 |
91 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
929 |
794 |
$2K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
218 |
213 |
$2K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
13 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
41 |
37 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
27 |
24 |
$1K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
15 |
14 |
$1K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
24 |
24 |
$951.52 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
210 |
183 |
$740.35 |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
32 |
12 |
$284.61 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
13 |
13 |
$202.43 |
| E0156 |
Seat attachment, walker |
24 |
24 |
$181.61 |
| A5120 |
Skin barrier, wipes or swabs, each |
28 |
26 |
$135.20 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
27 |
12 |
$95.61 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$95.22 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
18 |
14 |
$82.07 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$66.74 |
| 90656 |
|
312 |
308 |
$0.00 |
| 0012A |
|
227 |
227 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
266 |
265 |
$0.00 |
| 0064A |
|
363 |
363 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
2,574 |
2,548 |
$0.00 |
| 0134A |
|
413 |
413 |
$0.00 |
| 0011A |
|
576 |
576 |
$0.00 |
| 90686 |
|
2,127 |
2,107 |
$0.00 |
| 90688 |
|
124 |
122 |
$0.00 |
| 90480 |
|
752 |
734 |
$0.00 |
| 90732 |
|
91 |
91 |
$0.00 |
| 90677 |
|
80 |
80 |
$0.00 |
| 90670 |
|
45 |
44 |
$0.00 |
| 91320 |
|
752 |
734 |
$0.00 |