| 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 |
11,133 |
9,508 |
$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 |
3,525 |
3,422 |
$2.31M |
| B9998 |
Noc for enteral supplies |
14,674 |
10,654 |
$1.53M |
| 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 |
3,622 |
3,510 |
$998K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,900 |
6,736 |
$679K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
9,394 |
4,445 |
$571K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,873 |
1,826 |
$541K |
| 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 |
1,705 |
1,672 |
$429K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
678 |
658 |
$417K |
| 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 |
994 |
969 |
$389K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,975 |
1,948 |
$383K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,396 |
2,158 |
$307K |
| 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 |
148 |
136 |
$241K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
348 |
340 |
$236K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,343 |
1,191 |
$226K |
| A4554 |
Disposable underpads, all sizes |
4,935 |
4,626 |
$178K |
| A4322 |
Irrigation syringe, bulb or piston, each |
13,006 |
9,229 |
$148K |
| 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 |
316 |
302 |
$147K |
| K0001 |
Standard wheelchair |
3,960 |
3,742 |
$126K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,183 |
1,085 |
$122K |
| 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 |
963 |
934 |
$118K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,795 |
6,625 |
$116K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,367 |
1,215 |
$110K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
6,403 |
4,323 |
$96K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,759 |
4,603 |
$92K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,946 |
3,145 |
$87K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
729 |
662 |
$77K |
| A4605 |
Tracheal suction catheter, closed system, each |
634 |
513 |
$71K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
4,857 |
4,634 |
$65K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
767 |
741 |
$59K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
8,926 |
8,421 |
$55K |
| A7002 |
Tubing, used with suction pump, each |
4,755 |
3,217 |
$52K |
| 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 |
233 |
137 |
$44K |
| B4100 |
Food thickener, administered orally, per ounce |
179 |
173 |
$38K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
419 |
384 |
$37K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,516 |
906 |
$35K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,205 |
3,009 |
$34K |
| A4335 |
Incontinence supply; miscellaneous |
5,959 |
5,484 |
$27K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
156 |
139 |
$25K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
427 |
423 |
$25K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
95 |
95 |
$23K |
| B4082 |
Nasogastric tubing without stylet |
844 |
787 |
$20K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
160 |
147 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
3,575 |
3,284 |
$18K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
697 |
674 |
$18K |
| A4670 |
Automatic blood pressure monitor |
397 |
379 |
$17K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,391 |
3,030 |
$15K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
378 |
348 |
$12K |
| E0601 |
Continuous positive airway pressure (cpap) device |
211 |
201 |
$12K |
| 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 |
51 |
50 |
$12K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
170 |
166 |
$12K |
| E0776 |
Iv pole |
189 |
185 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
449 |
366 |
$11K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,255 |
602 |
$9K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
130 |
123 |
$8K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
290 |
264 |
$7K |
| A4402 |
Lubricant, per ounce |
1,678 |
1,589 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,528 |
2,446 |
$5K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
41 |
40 |
$5K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
662 |
395 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
612 |
495 |
$4K |
| E0570 |
Nebulizer, with compressor |
54 |
51 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
26 |
26 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,089 |
742 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
72 |
67 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
19 |
14 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
191 |
178 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12 |
12 |
$1K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
12 |
12 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
13 |
13 |
$434.94 |
| A4452 |
Tape, waterproof, per 18 square inches |
52 |
52 |
$281.21 |
| A7015 |
Aerosol mask, used with dme nebulizer |
266 |
250 |
$263.12 |
| A7525 |
Tracheostomy mask, each |
113 |
106 |
$209.47 |
| A4456 |
Adhesive remover, wipes, any type, each |
17 |
12 |
$140.55 |
| A4371 |
Ostomy skin barrier, powder, per oz |
13 |
12 |
$62.70 |
| B4104 |
Additive for enteral formula (e.g., fiber) |
126 |
119 |
$3.36 |