| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
7,045 |
6,182 |
$4.43M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
48,289 |
40,933 |
$1.79M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,477 |
2,156 |
$1.35M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
57,786 |
41,307 |
$973K |
| 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 |
40,693 |
28,916 |
$813K |
| 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 |
19,477 |
14,017 |
$703K |
| 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 |
13,084 |
9,515 |
$282K |
| B9002 |
Enteral nutrition infusion pump, any type |
24,488 |
21,761 |
$220K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,403 |
11,250 |
$168K |
| A4623 |
Tracheostomy, inner cannula |
11,550 |
9,454 |
$152K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
58,653 |
48,862 |
$96K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
8,861 |
7,434 |
$66K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
5,373 |
4,438 |
$63K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
9,024 |
7,412 |
$62K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
70,370 |
58,887 |
$62K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,264 |
1,841 |
$54K |
| A7526 |
Tracheostomy tube collar/holder, each |
9,589 |
8,034 |
$53K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
6,193 |
5,027 |
$46K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
12,686 |
10,590 |
$43K |
| E0776 |
Iv pole |
40,882 |
38,053 |
$41K |
| 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 |
429 |
348 |
$36K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,729 |
1,410 |
$34K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,130 |
888 |
$33K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,479 |
2,133 |
$29K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
789 |
650 |
$23K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
4,452 |
3,642 |
$21K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,080 |
2,490 |
$21K |
| A6252 |
Specialty absorptive 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 |
2,827 |
2,246 |
$19K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
8,059 |
6,567 |
$18K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
2,427 |
2,004 |
$16K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
3,022 |
2,538 |
$16K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,523 |
2,231 |
$14K |
| 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 |
3,322 |
2,466 |
$13K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
4,175 |
3,611 |
$13K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
1,847 |
1,504 |
$12K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
7,478 |
6,278 |
$10K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
2,129 |
1,777 |
$10K |
| E0277 |
Powered pressure-reducing air mattress |
97 |
91 |
$10K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,561 |
1,368 |
$8K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,802 |
2,325 |
$8K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,548 |
2,967 |
$6K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
4,397 |
3,618 |
$6K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
666 |
585 |
$5K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
2,379 |
2,093 |
$4K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,477 |
1,238 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,180 |
2,773 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
6,425 |
5,445 |
$3K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
467 |
390 |
$2K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
596 |
540 |
$2K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
1,314 |
1,080 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
409 |
351 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,293 |
1,837 |
$2K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
97 |
77 |
$2K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
475 |
394 |
$2K |
| A4354 |
Insertion tray with drainage bag but without catheter |
2,865 |
2,513 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
480 |
401 |
$2K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
253 |
203 |
$1K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
279 |
226 |
$1K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
370 |
274 |
$1K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
489 |
419 |
$1K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
94 |
82 |
$613.06 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,742 |
1,534 |
$444.80 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
493 |
450 |
$439.07 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
246 |
217 |
$410.15 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,589 |
1,360 |
$364.42 |
| A5120 |
Skin barrier, wipes or swabs, each |
1,051 |
911 |
$346.11 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
150 |
135 |
$322.72 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
113 |
90 |
$267.68 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
331 |
287 |
$214.43 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
93 |
79 |
$208.80 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
96 |
84 |
$207.14 |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,008 |
857 |
$206.17 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
89 |
63 |
$133.09 |
| A4456 |
Adhesive remover, wipes, any type, each |
165 |
155 |
$107.16 |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
15 |
12 |
$95.57 |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
13 |
12 |
$83.62 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
114 |
100 |
$67.34 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
44 |
38 |
$66.75 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
414 |
361 |
$41.80 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
61 |
53 |
$38.41 |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
42 |
40 |
$31.08 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
15 |
13 |
$8.15 |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
14 |
12 |
$0.00 |