| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,518 |
2,373 |
$5.90M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,747 |
1,645 |
$3.50M |
| 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 |
11,223 |
9,378 |
$2.03M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
5,734 |
5,428 |
$1.71M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,998 |
4,607 |
$1.49M |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
4,302 |
4,105 |
$1.32M |
| 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) |
2,190 |
2,033 |
$1.09M |
| E1399 |
Durable medical equipment, miscellaneous |
2,676 |
2,135 |
$924K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,504 |
2,053 |
$769K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
2,017 |
1,580 |
$677K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,903 |
8,454 |
$621K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,630 |
4,839 |
$575K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,241 |
1,912 |
$545K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
7,434 |
6,940 |
$441K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
860 |
799 |
$347K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,200 |
2,098 |
$329K |
| 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 |
852 |
780 |
$302K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,161 |
2,116 |
$299K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
675 |
622 |
$292K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,332 |
1,237 |
$276K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,080 |
1,001 |
$275K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,337 |
3,134 |
$265K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,036 |
930 |
$265K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,344 |
1,214 |
$253K |
| A4605 |
Tracheal suction catheter, closed system, each |
763 |
645 |
$235K |
| E1240 |
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest |
2,013 |
1,989 |
$225K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
709 |
678 |
$197K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,911 |
3,734 |
$182K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
2,018 |
1,913 |
$143K |
| E0570 |
Nebulizer, with compressor |
619 |
597 |
$133K |
| 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 |
1,335 |
1,123 |
$127K |
| 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 |
956 |
815 |
$126K |
| 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) |
824 |
781 |
$116K |
| A4217 |
Sterile water/saline, 500 ml |
2,477 |
2,207 |
$115K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,259 |
1,173 |
$110K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
779 |
708 |
$96K |
| A7035 |
Headgear used with positive airway pressure device |
2,049 |
1,973 |
$87K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,251 |
2,066 |
$84K |
| A7037 |
Tubing used with positive airway pressure device |
1,807 |
1,763 |
$84K |
| A4618 |
Breathing circuits |
1,644 |
1,325 |
$73K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
543 |
490 |
$72K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
404 |
388 |
$71K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,525 |
1,475 |
$69K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
443 |
404 |
$67K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
1,014 |
959 |
$48K |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
457 |
439 |
$42K |
| A4927 |
Gloves, non-sterile, per 100 |
1,717 |
1,461 |
$40K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
608 |
494 |
$39K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,603 |
2,413 |
$37K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,477 |
6,160 |
$37K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
263 |
261 |
$36K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
422 |
405 |
$35K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
335 |
297 |
$33K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
370 |
364 |
$33K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,860 |
2,750 |
$26K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,451 |
2,267 |
$25K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
911 |
888 |
$25K |
| 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 |
594 |
558 |
$23K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,013 |
1,799 |
$22K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,032 |
968 |
$21K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,052 |
2,933 |
$15K |
| A5120 |
Skin barrier, wipes or swabs, each |
772 |
730 |
$14K |
| E0481 |
Intrapulmonary percussive ventilation system and related accessories |
49 |
48 |
$13K |
| A4626 |
Tracheostomy cleaning brush, each |
941 |
898 |
$13K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
256 |
248 |
$13K |
| A4649 |
Surgical supply; miscellaneous |
947 |
408 |
$10K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
573 |
563 |
$10K |
| A4620 |
Variable concentration mask |
1,632 |
1,553 |
$9K |
| K0003 |
Lightweight wheelchair |
94 |
92 |
$7K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,108 |
1,065 |
$6K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
65 |
65 |
$5K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
104 |
98 |
$5K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
371 |
340 |
$4K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
27 |
24 |
$4K |
| A4215 |
Needle, sterile, any size, each |
955 |
924 |
$3K |
| A4245 |
Alcohol wipes, per box |
813 |
786 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
389 |
373 |
$2K |
| A4615 |
Cannula, nasal |
938 |
846 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
368 |
346 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
14 |
14 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
12 |
12 |
$1K |
| E0271 |
Mattress, innerspring |
227 |
215 |
$736.55 |
| A4367 |
Ostomy belt, each |
93 |
88 |
$514.48 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
40 |
38 |
$359.07 |