| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,287 |
855 |
$51K |
| 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 |
1,328 |
882 |
$46K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
1,984 |
1,780 |
$30K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,332 |
1,296 |
$12K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
355 |
240 |
$6K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
48 |
48 |
$6K |
| E0570 |
Nebulizer, with compressor |
75 |
67 |
$4K |
| K0001 |
Standard wheelchair |
144 |
121 |
$3K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
195 |
193 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
74 |
69 |
$777.20 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$85.50 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$29.48 |