| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,604 |
5,170 |
$357K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,442 |
1,214 |
$320K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,179 |
1,447 |
$150K |
| 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 |
2,937 |
1,747 |
$138K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
2,529 |
863 |
$112K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
475 |
361 |
$95K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,641 |
1,040 |
$67K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,680 |
1,428 |
$66K |
| 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 |
326 |
294 |
$60K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,303 |
1,200 |
$60K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
399 |
376 |
$30K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,603 |
1,292 |
$26K |
| E1392 |
Portable oxygen concentrator, rental |
3,312 |
2,702 |
$22K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
391 |
271 |
$20K |
| 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 |
146 |
105 |
$14K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,069 |
809 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,672 |
1,573 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
782 |
535 |
$6K |
| E0570 |
Nebulizer, with compressor |
587 |
439 |
$5K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
425 |
284 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
1,050 |
756 |
$3K |
| B9998 |
Noc for enteral supplies |
37 |
36 |
$3K |
| E0776 |
Iv pole |
1,130 |
808 |
$3K |
| 99601 |
|
28 |
13 |
$2K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
130 |
112 |
$2K |
| A7526 |
Tracheostomy tube collar/holder, each |
449 |
330 |
$2K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
223 |
70 |
$1K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
27 |
27 |
$667.72 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
542 |
405 |
$547.36 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
29 |
25 |
$411.65 |
| K0001 |
Standard wheelchair |
164 |
146 |
$230.29 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
15 |
12 |
$166.91 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
15 |
12 |
$143.57 |
| A4623 |
Tracheostomy, inner cannula |
19 |
12 |
$100.22 |
| 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 |
42 |
39 |
$0.00 |