| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
42,126 |
36,461 |
$9.88M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
63,176 |
58,591 |
$9.05M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
36,202 |
26,167 |
$7.57M |
| E0784 |
External ambulatory infusion pump, insulin |
4,448 |
3,960 |
$7.06M |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
24,505 |
21,173 |
$4.86M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
39,059 |
35,266 |
$4.27M |
| T4541 |
Incontinence product, disposable underpad, large, each |
162,140 |
137,322 |
$4.11M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
55,619 |
45,689 |
$3.99M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
65,339 |
53,985 |
$3.90M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
62,538 |
51,891 |
$3.56M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
7,828 |
6,498 |
$3.46M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
77,847 |
67,350 |
$3.24M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
31,803 |
24,816 |
$2.91M |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
28,987 |
24,555 |
$2.78M |
| 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 |
52,883 |
46,698 |
$2.71M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
24,818 |
21,587 |
$2.68M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
36,163 |
32,963 |
$2.62M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
35,983 |
30,777 |
$2.51M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
27,756 |
24,409 |
$2.49M |
| A6210 |
Foam 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 |
16,575 |
14,064 |
$2.44M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
86,536 |
74,807 |
$2.13M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
5,736 |
4,790 |
$1.99M |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
48,883 |
44,195 |
$1.95M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
29,002 |
23,868 |
$1.92M |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
29,755 |
25,177 |
$1.85M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
37,790 |
32,767 |
$1.81M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
30,071 |
25,129 |
$1.65M |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
15,222 |
13,308 |
$1.54M |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
58,671 |
51,575 |
$1.45M |
| 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 |
3,042 |
2,648 |
$1.42M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
4,654 |
4,056 |
$1.33M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
39,242 |
35,465 |
$1.32M |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
24,132 |
21,688 |
$1.32M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
19,027 |
15,403 |
$1.28M |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
30,947 |
26,659 |
$1.25M |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
42,298 |
38,129 |
$1.15M |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
2,364 |
2,175 |
$1.07M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
17,565 |
15,760 |
$1.04M |
| A4927 |
Gloves, non-sterile, per 100 |
132,700 |
122,848 |
$1.03M |
| A4452 |
Tape, waterproof, per 18 square inches |
59,638 |
53,377 |
$930K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
8,620 |
7,196 |
$825K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
9,941 |
8,824 |
$799K |
| A4554 |
Disposable underpads, all sizes |
21,830 |
14,591 |
$796K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
7,594 |
6,556 |
$753K |
| 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 |
5,316 |
3,990 |
$724K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
10,475 |
9,104 |
$697K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
2,166 |
1,812 |
$694K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
22,852 |
19,098 |
$679K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
9,088 |
8,174 |
$668K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12,226 |
10,315 |
$645K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
72,730 |
64,992 |
$601K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
8,845 |
7,875 |
$601K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
9,773 |
8,415 |
$576K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
6,449 |
5,513 |
$555K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
6,212 |
4,555 |
$548K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,301 |
1,911 |
$546K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
4,884 |
4,306 |
$504K |
| 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 |
9,009 |
6,782 |
$503K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
27,703 |
23,634 |
$472K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
9,505 |
8,780 |
$463K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,585 |
2,033 |
$448K |
| 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 |
12,333 |
10,904 |
$448K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
9,184 |
7,688 |
$445K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
1,979 |
1,699 |
$425K |
| A5120 |
Skin barrier, wipes or swabs, each |
80,980 |
73,560 |
$404K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
33,728 |
30,116 |
$391K |
| 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 |
4,435 |
3,313 |
$380K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,796 |
9,479 |
$314K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
7,373 |
6,647 |
$304K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
4,983 |
4,326 |
$302K |
| A4456 |
Adhesive remover, wipes, any type, each |
45,784 |
40,451 |
$299K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
5,930 |
5,023 |
$298K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
4,201 |
3,572 |
$297K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
38,846 |
35,634 |
$282K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
8,206 |
6,849 |
$278K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
7,230 |
6,068 |
$273K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,471 |
3,358 |
$265K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
14,360 |
13,487 |
$262K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
6,100 |
5,516 |
$254K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,994 |
3,465 |
$240K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
5,050 |
4,536 |
$237K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
51,995 |
47,638 |
$232K |
| 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 |
2,886 |
2,108 |
$221K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
28,380 |
25,363 |
$220K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
2,508 |
2,067 |
$202K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
4,692 |
3,115 |
$197K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
1,145 |
966 |
$195K |
| A4670 |
Automatic blood pressure monitor |
4,335 |
4,222 |
$180K |
| A4371 |
Ostomy skin barrier, powder, per oz |
39,396 |
35,831 |
$170K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
10,968 |
9,784 |
$170K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
9,695 |
8,673 |
$164K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,463 |
2,283 |
$157K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
12,476 |
11,803 |
$150K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
2,287 |
1,965 |
$142K |
| B9998 |
Noc for enteral supplies |
2,733 |
1,938 |
$141K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
7,485 |
6,241 |
$141K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,413 |
3,020 |
$131K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
6,870 |
5,725 |
$130K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
4,040 |
3,588 |
$130K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
2,204 |
1,881 |
$129K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
9,370 |
8,361 |
$128K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
1,863 |
1,389 |
$127K |
| A4231 |
Infusion set for external insulin pump, needle type |
1,350 |
1,186 |
$126K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
1,684 |
1,482 |
$122K |
| A4392 |
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
1,764 |
1,618 |
$122K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
4,461 |
3,950 |
$120K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,443 |
2,359 |
$119K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
4,433 |
3,773 |
$117K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
2,162 |
2,017 |
$116K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
5,165 |
4,265 |
$115K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
2,036 |
1,817 |
$110K |
| A4217 |
Sterile water/saline, 500 ml |
16,578 |
15,581 |
$107K |
| 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 |
2,340 |
2,072 |
$106K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
3,127 |
2,642 |
$104K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12,797 |
11,404 |
$99K |
| A4367 |
Ostomy belt, each |
23,708 |
21,410 |
$97K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
3,100 |
2,801 |
$88K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,900 |
1,628 |
$87K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
6,872 |
5,544 |
$84K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,904 |
1,725 |
$73K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
7,668 |
6,491 |
$73K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
6,238 |
5,601 |
$68K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
3,525 |
2,935 |
$65K |
| A4930 |
Gloves, sterile, per pair |
2,816 |
2,492 |
$62K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
1,886 |
1,537 |
$62K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,467 |
2,123 |
$60K |
| A4408 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
855 |
663 |
$59K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
5,494 |
4,762 |
$56K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,550 |
4,068 |
$55K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
1,077 |
938 |
$54K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
7,442 |
6,712 |
$53K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
2,597 |
2,502 |
$51K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
796 |
646 |
$51K |
| A4396 |
Ostomy belt with peristomal hernia support |
2,470 |
2,170 |
$50K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,844 |
2,534 |
$50K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
520 |
436 |
$41K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
11,029 |
9,807 |
$40K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
1,154 |
1,037 |
$38K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
9,705 |
8,860 |
$37K |
| A4402 |
Lubricant, per ounce |
9,481 |
8,655 |
$36K |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
883 |
757 |
$35K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,706 |
1,393 |
$33K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,130 |
947 |
$32K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
1,898 |
1,718 |
$32K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,689 |
1,526 |
$31K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
580 |
527 |
$29K |
| A6235 |
Hydrocolloid 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 |
266 |
228 |
$29K |
| A4335 |
Incontinence supply; miscellaneous |
6,908 |
4,396 |
$29K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
2,534 |
2,194 |
$27K |
| A4259 |
Lancets, per box of 100 |
4,559 |
3,929 |
$27K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,770 |
1,632 |
$27K |
| A6243 |
Hydrogel 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 |
135 |
115 |
$26K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
1,227 |
999 |
$26K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
471 |
422 |
$23K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,757 |
1,635 |
$23K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
2,013 |
1,831 |
$22K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,886 |
1,747 |
$22K |
| A6242 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
277 |
242 |
$21K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
795 |
690 |
$21K |
| A4332 |
Lubricant, individual sterile packet, each |
2,765 |
2,329 |
$19K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
3,059 |
2,723 |
$18K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
2,135 |
1,933 |
$16K |
| A5055 |
Stoma cap |
619 |
573 |
$15K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
520 |
457 |
$15K |
| 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 |
811 |
752 |
$15K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
403 |
346 |
$13K |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
1,804 |
1,564 |
$13K |
| A4649 |
Surgical supply; miscellaneous |
1,341 |
910 |
$13K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
2,197 |
1,915 |
$12K |
| A4326 |
Male external catheter with integral collection chamber, any type, each |
83 |
66 |
$12K |
| A4391 |
Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each |
223 |
205 |
$12K |
| B4100 |
Food thickener, administered orally, per ounce |
240 |
214 |
$11K |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
687 |
629 |
$10K |
| A6260 |
Wound cleansers, any type, any size |
2,258 |
2,073 |
$9K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
277 |
210 |
$9K |
| A9270 |
Non-covered item or service |
5,331 |
3,723 |
$9K |
| A4354 |
Insertion tray with drainage bag but without catheter |
236 |
98 |
$9K |
| A4433 |
Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each |
323 |
234 |
$8K |
| A5071 |
Ostomy pouch, urinary; with barrier attached (1 piece), each |
129 |
115 |
$8K |
| A6204 |
Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
143 |
108 |
$8K |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
364 |
295 |
$7K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,442 |
2,166 |
$7K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
3,092 |
2,691 |
$6K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
304 |
254 |
$6K |
| A4215 |
Needle, sterile, any size, each |
215 |
206 |
$5K |
| A4245 |
Alcohol wipes, per box |
2,710 |
2,537 |
$5K |
| A5052 |
Ostomy pouch, closed; without barrier attached (1 piece), each |
114 |
106 |
$5K |
| A5102 |
Bedside drainage bottle with or without tubing, rigid or expandable, each |
401 |
355 |
$5K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
605 |
565 |
$4K |
| A4404 |
Ostomy ring, each |
216 |
208 |
$4K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
70 |
66 |
$4K |
| E1399 |
Durable medical equipment, miscellaneous |
147 |
120 |
$4K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
46 |
37 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
100 |
93 |
$3K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
66 |
65 |
$3K |
| ZZZZZ |
|
57 |
42 |
$3K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
535 |
460 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
150 |
121 |
$2K |
| 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 |
45 |
37 |
$2K |
| A4246 |
Betadine or phisohex solution, per pint |
103 |
102 |
$2K |
| A6224 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
31 |
25 |
$2K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
90 |
89 |
$2K |
| A4363 |
Ostomy clamp, any type, replacement only, each |
719 |
621 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
14 |
12 |
$1K |
| A4421 |
Ostomy supply; miscellaneous |
278 |
207 |
$853.96 |
| A5081 |
Stoma plug or seal, any type |
15 |
12 |
$427.12 |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
16 |
12 |
$413.78 |
| A6444 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard |
19 |
13 |
$395.51 |
| A6455 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
13 |
12 |
$348.57 |
| A7526 |
Tracheostomy tube collar/holder, each |
13 |
12 |
$348.27 |
| A4426 |
Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each |
13 |
13 |
$323.33 |
| A4366 |
Ostomy vent, any type, each |
25 |
25 |
$205.99 |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
20 |
13 |
$77.26 |