| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,547 |
3,436 |
$2.92M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,887 |
8,675 |
$2.71M |
| 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 |
5,772 |
5,633 |
$1.53M |
| B9998 |
Noc for enteral supplies |
14,249 |
10,657 |
$1.42M |
| E0570 |
Nebulizer, with compressor |
13,810 |
13,609 |
$1.34M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,453 |
1,433 |
$1.32M |
| 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 |
2,715 |
2,582 |
$1.15M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,323 |
8,200 |
$1.03M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,318 |
2,278 |
$653K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
4,303 |
3,716 |
$488K |
| 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 |
1,424 |
1,329 |
$435K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,355 |
6,286 |
$412K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,615 |
1,551 |
$277K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,666 |
2,530 |
$257K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,389 |
2,362 |
$252K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
9,568 |
9,404 |
$246K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13,872 |
13,713 |
$237K |
| 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 |
838 |
808 |
$223K |
| B9002 |
Enteral nutrition infusion pump, any type |
708 |
691 |
$221K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
15,690 |
9,974 |
$208K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
2,238 |
2,098 |
$189K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
523 |
507 |
$175K |
| A4554 |
Disposable underpads, all sizes |
5,498 |
5,340 |
$168K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,856 |
1,811 |
$168K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,482 |
7,407 |
$167K |
| 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) |
891 |
880 |
$160K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,329 |
1,283 |
$139K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
988 |
959 |
$134K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,194 |
4,110 |
$122K |
| A4605 |
Tracheal suction catheter, closed system, each |
605 |
581 |
$89K |
| A4322 |
Irrigation syringe, bulb or piston, each |
8,734 |
8,454 |
$89K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,144 |
1,013 |
$87K |
| A7002 |
Tubing, used with suction pump, each |
4,272 |
4,141 |
$85K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
3,148 |
3,100 |
$82K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,638 |
1,588 |
$70K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,176 |
2,060 |
$68K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,648 |
1,634 |
$67K |
| A7037 |
Tubing used with positive airway pressure device |
3,451 |
3,411 |
$65K |
| A4335 |
Incontinence supply; miscellaneous |
9,369 |
8,925 |
$57K |
| A4217 |
Sterile water/saline, 500 ml |
1,290 |
1,218 |
$53K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
716 |
710 |
$47K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
474 |
460 |
$45K |
| A7035 |
Headgear used with positive airway pressure device |
1,908 |
1,885 |
$38K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,752 |
1,710 |
$33K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,571 |
6,380 |
$31K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
4,497 |
4,369 |
$29K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
215 |
209 |
$29K |
| K0001 |
Standard wheelchair |
738 |
727 |
$28K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
180 |
132 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
3,025 |
2,922 |
$25K |
| A7015 |
Aerosol mask, used with dme nebulizer |
17,368 |
17,120 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,929 |
3,880 |
$21K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,258 |
5,130 |
$18K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
170 |
167 |
$16K |
| E1399 |
Durable medical equipment, miscellaneous |
99 |
88 |
$13K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
352 |
347 |
$12K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,404 |
6,283 |
$10K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
16 |
12 |
$9K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
14,724 |
14,549 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
829 |
782 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
605 |
593 |
$8K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
54 |
52 |
$8K |
| A4657 |
Syringe, with or without needle, each |
1,103 |
1,083 |
$6K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
122 |
121 |
$5K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
994 |
929 |
$5K |
| B4100 |
Food thickener, administered orally, per ounce |
95 |
88 |
$4K |
| B4082 |
Nasogastric tubing without stylet |
53 |
49 |
$4K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
24 |
24 |
$3K |
| A4332 |
Lubricant, individual sterile packet, each |
5,395 |
5,256 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
213 |
207 |
$2K |
| A7525 |
Tracheostomy mask, each |
494 |
397 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
115 |
93 |
$1K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
12 |
12 |
$62.33 |