| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
68,529 |
31,714 |
$3.43M |
| S5165 |
Home modifications; per service |
35,390 |
9,478 |
$3.16M |
| J2426 |
Injection, paliperidone palmitate extended release (invega sustenna), 1 mg |
712 |
560 |
$2.24M |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,280 |
3,997 |
$1.81M |
| E1090 |
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests |
3,380 |
3,092 |
$1.54M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
25,829 |
19,226 |
$1.15M |
| E0627 |
Seat lift mechanism, electric, any type |
6,779 |
5,278 |
$1.08M |
| E0635 |
Patient lift, electric with seat or sling |
2,486 |
1,909 |
$972K |
| J0401 |
Injection, aripiprazole (abilify maintena), 1 mg |
437 |
352 |
$970K |
| 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 |
7,583 |
5,255 |
$648K |
| E0601 |
Continuous positive airway pressure (cpap) device |
12,246 |
10,388 |
$492K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
454 |
363 |
$394K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
4,696 |
3,657 |
$321K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
4,226 |
2,194 |
$317K |
| 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 |
2,926 |
1,826 |
$309K |
| E1290 |
Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest |
842 |
775 |
$291K |
| E1260 |
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest |
2,671 |
2,471 |
$275K |
| 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 |
800 |
520 |
$255K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
609 |
318 |
$250K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,065 |
828 |
$245K |
| L7364 |
Twelve volt battery, each |
554 |
315 |
$240K |
| 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) |
3,054 |
2,558 |
$231K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
2,014 |
1,470 |
$220K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
2,765 |
2,122 |
$218K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
1,878 |
1,356 |
$168K |
| E1240 |
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest |
1,050 |
971 |
$156K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
853 |
619 |
$156K |
| E0570 |
Nebulizer, with compressor |
9,426 |
7,738 |
$148K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,849 |
4,910 |
$130K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,538 |
1,752 |
$123K |
| E0294 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
4,823 |
3,918 |
$114K |
| L7366 |
Battery charger, twelve volt, each |
387 |
253 |
$113K |
| E1250 |
Lightweight wheelchair, fixed full length arms, swing away detachable footrest |
1,212 |
1,120 |
$110K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,133 |
10,418 |
$108K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
695 |
480 |
$103K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
4,522 |
3,566 |
$101K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,791 |
1,445 |
$100K |
| E0244 |
Raised toilet seat |
1,889 |
1,444 |
$96K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,804 |
2,169 |
$90K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,721 |
3,089 |
$89K |
| E1399 |
Durable medical equipment, miscellaneous |
70 |
49 |
$78K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
603 |
389 |
$73K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,614 |
1,907 |
$67K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
5,043 |
3,768 |
$60K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,752 |
1,340 |
$60K |
| E0305 |
Bed side rails, half length |
5,203 |
4,308 |
$50K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,437 |
2,058 |
$50K |
| E0155 |
Wheel attachment, rigid pick-up walker, per pair |
4,072 |
3,390 |
$50K |
| E0156 |
Seat attachment, walker |
5,339 |
4,153 |
$43K |
| E1392 |
Portable oxygen concentrator, rental |
2,571 |
1,859 |
$42K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
31 |
27 |
$42K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,065 |
870 |
$41K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,402 |
1,091 |
$39K |
| A7035 |
Headgear used with positive airway pressure device |
3,251 |
2,665 |
$38K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,813 |
2,996 |
$36K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
2,380 |
1,196 |
$35K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,202 |
1,005 |
$35K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
2,691 |
1,345 |
$33K |
| E0241 |
Bath tub wall rail, each |
1,194 |
813 |
$30K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
795 |
638 |
$30K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
161 |
130 |
$29K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,317 |
1,043 |
$28K |
| 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 |
812 |
350 |
$25K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
771 |
629 |
$24K |
| A4670 |
Automatic blood pressure monitor |
533 |
464 |
$23K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
193 |
145 |
$23K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
260 |
175 |
$20K |
| B9002 |
Enteral nutrition infusion pump, any type |
376 |
269 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,401 |
5,305 |
$17K |
| E0912 |
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar |
412 |
325 |
$16K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
139 |
121 |
$16K |
| K0003 |
Lightweight wheelchair |
4,749 |
4,157 |
$15K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
161 |
136 |
$15K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
691 |
577 |
$15K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
141 |
98 |
$15K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
143 |
104 |
$14K |
| 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 |
1,193 |
854 |
$11K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
18 |
12 |
$10K |
| E2612 |
General use wheelchair back cushion, width 22 inches or greater, any height, including any type mounting hardware |
35 |
29 |
$9K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
775 |
642 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,428 |
1,161 |
$8K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
75 |
55 |
$7K |
| E2604 |
Skin protection wheelchair seat cushion, width 22 inches or greater, any depth |
34 |
29 |
$7K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
219 |
145 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,667 |
1,638 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
437 |
320 |
$5K |
| E0271 |
Mattress, innerspring |
110 |
87 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
297 |
287 |
$4K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
78 |
38 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
220 |
150 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,525 |
2,088 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
293 |
189 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
60 |
52 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
186 |
127 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
197 |
121 |
$3K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
24 |
12 |
$3K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
55 |
38 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
145 |
126 |
$2K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
46 |
40 |
$2K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
3,280 |
2,759 |
$2K |
| E1020 |
Residual limb support system for wheelchair, any type |
100 |
74 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
63 |
51 |
$2K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
159 |
140 |
$2K |
| E0272 |
Mattress, foam rubber |
18 |
13 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
378 |
255 |
$1K |
| E0705 |
Transfer device, any type, each |
32 |
27 |
$1K |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
736 |
423 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
50 |
37 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$878.02 |
| E0243 |
Toilet rail, each |
16 |
12 |
$790.00 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
206 |
154 |
$737.23 |
| A5120 |
Skin barrier, wipes or swabs, each |
101 |
76 |
$433.54 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
20 |
14 |
$427.70 |
| A7015 |
Aerosol mask, used with dme nebulizer |
408 |
338 |
$305.11 |
| A7002 |
Tubing, used with suction pump, each |
17 |
12 |
$214.35 |
| A4259 |
Lancets, per box of 100 |
872 |
631 |
$189.87 |
| E0441 |
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
143 |
135 |
$143.40 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
40 |
24 |
$82.50 |
| E0607 |
Home blood glucose monitor |
28 |
18 |
$37.62 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
1,145 |
749 |
$25.87 |
| K0006 |
Heavy duty wheelchair |
43 |
37 |
$0.00 |
| A9270 |
Non-covered item or service |
217 |
171 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
48 |
48 |
$0.00 |
| 90674 |
|
17 |
17 |
$0.00 |