| 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 |
15,645 |
13,199 |
$1.94M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
36,413 |
33,219 |
$1.25M |
| 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 |
2,221 |
1,832 |
$1.06M |
| 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 |
8,460 |
7,227 |
$565K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
18,371 |
16,798 |
$530K |
| 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 |
1,968 |
1,648 |
$493K |
| 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 |
5,742 |
4,950 |
$455K |
| 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 |
3,083 |
2,671 |
$378K |
| B9002 |
Enteral nutrition infusion pump, any type |
7,063 |
6,208 |
$344K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,002 |
6,208 |
$253K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,811 |
7,854 |
$176K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,575 |
3,206 |
$155K |
| 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 |
604 |
501 |
$150K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,827 |
2,549 |
$110K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,399 |
2,202 |
$89K |
| 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) |
1,621 |
1,434 |
$84K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,874 |
4,337 |
$79K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,554 |
3,176 |
$71K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
281 |
231 |
$66K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,527 |
2,315 |
$62K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,331 |
2,144 |
$59K |
| 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 |
461 |
384 |
$41K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,283 |
9,365 |
$40K |
| A7035 |
Headgear used with positive airway pressure device |
3,747 |
3,420 |
$38K |
| A7037 |
Tubing used with positive airway pressure device |
4,107 |
3,760 |
$37K |
| E0776 |
Iv pole |
4,799 |
4,419 |
$36K |
| E0570 |
Nebulizer, with compressor |
7,857 |
7,177 |
$35K |
| K0001 |
Standard wheelchair |
3,591 |
2,875 |
$26K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,301 |
1,193 |
$25K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,809 |
2,561 |
$16K |
| E1392 |
Portable oxygen concentrator, rental |
2,389 |
2,233 |
$16K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
947 |
871 |
$15K |
| B9998 |
Noc for enteral supplies |
1,141 |
1,010 |
$12K |
| 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 |
74 |
57 |
$12K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,344 |
1,245 |
$10K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
474 |
430 |
$10K |
| B4100 |
Food thickener, administered orally, per ounce |
94 |
79 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,792 |
1,672 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,210 |
883 |
$4K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
91 |
65 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,017 |
1,796 |
$2K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
146 |
130 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
260 |
158 |
$315.38 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
26 |
26 |
$257.07 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$81.31 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
104 |
92 |
$35.21 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
20 |
16 |
$17.80 |