| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
347 |
210 |
$55K |
| A0429 |
Ambulance service, basic life support, emergency transport (bls-emergency) |
440 |
397 |
$53K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
440 |
409 |
$53K |
| E0601 |
Continuous positive airway pressure (cpap) device |
409 |
382 |
$31K |
| A0130 |
Non-emergency transportation: wheelchair van |
684 |
68 |
$24K |
| A0425 |
Ground mileage, per statute mile |
1,993 |
1,075 |
$15K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
154 |
149 |
$10K |
| K0001 |
Standard wheelchair |
285 |
272 |
$9K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
176 |
168 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
102 |
102 |
$8K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
444 |
421 |
$7K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
110 |
110 |
$7K |
| K0003 |
Lightweight wheelchair |
99 |
93 |
$6K |
| A0426 |
Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
30 |
29 |
$6K |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
49 |
45 |
$3K |
| E0570 |
Nebulizer, with compressor |
16 |
16 |
$1K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
140 |
93 |
$856.68 |
| A7035 |
Headgear used with positive airway pressure device |
69 |
68 |
$726.53 |
| J3490 |
Unclassified drugs |
185 |
102 |
$403.98 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
59 |
58 |
$270.29 |
| A7037 |
Tubing used with positive airway pressure device |
69 |
68 |
$221.48 |
| E0156 |
Seat attachment, walker |
25 |
25 |
$99.89 |
| J7050 |
Infusion, normal saline solution, 250 cc |
95 |
70 |
$72.81 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
30 |
28 |
$17.87 |
| A0380 |
Bls mileage (per mile) |
362 |
37 |
$10.40 |
| A0999 |
Unlisted ambulance service |
224 |
180 |
$0.00 |
| A0398 |
Als routine disposable supplies |
78 |
74 |
$0.00 |
| S9379 |
Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
26 |
26 |
$0.00 |
| A0424 |
Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review) |
225 |
214 |
$0.00 |
| T4541 |
Incontinence product, disposable underpad, large, each |
129 |
129 |
$0.00 |
| A0422 |
Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation |
27 |
24 |
$0.00 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
26 |
25 |
$0.00 |