| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
6,440 |
3,814 |
$5.07M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
110,915 |
101,359 |
$3.55M |
| E0570 |
Nebulizer, with compressor |
29,333 |
27,627 |
$1.08M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,739 |
3,648 |
$874K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
95,829 |
90,884 |
$639K |
| E0601 |
Continuous positive airway pressure (cpap) device |
45,712 |
44,405 |
$621K |
| A7030 |
Full face mask used with positive airway pressure device, each |
15,037 |
14,319 |
$552K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,919 |
2,385 |
$523K |
| A7526 |
Tracheostomy tube collar/holder, each |
6,195 |
5,221 |
$507K |
| K0001 |
Standard wheelchair |
21,428 |
20,238 |
$368K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
6,245 |
3,939 |
$366K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,089 |
1,622 |
$354K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
4,187 |
3,539 |
$278K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,206 |
1,007 |
$248K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
6,443 |
6,124 |
$228K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
8,706 |
8,415 |
$225K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
21,940 |
21,213 |
$223K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
6,869 |
6,505 |
$221K |
| A7031 |
Face mask interface, replacement for full face mask, each |
11,557 |
10,756 |
$214K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
2,790 |
2,434 |
$194K |
| 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 |
333 |
238 |
$193K |
| A4623 |
Tracheostomy, inner cannula |
1,488 |
1,235 |
$184K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,823 |
6,514 |
$172K |
| 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 |
668 |
522 |
$168K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,395 |
3,139 |
$162K |
| A7037 |
Tubing used with positive airway pressure device |
15,278 |
14,569 |
$154K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,892 |
1,787 |
$148K |
| A7035 |
Headgear used with positive airway pressure device |
15,349 |
14,650 |
$115K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
6,713 |
6,307 |
$106K |
| A7000 |
Canister, disposable, used with suction pump, each |
7,023 |
5,950 |
$83K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
36,620 |
34,759 |
$76K |
| K0003 |
Lightweight wheelchair |
2,533 |
2,349 |
$59K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
251 |
186 |
$57K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,775 |
4,333 |
$55K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
4,068 |
3,833 |
$51K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,331 |
1,258 |
$48K |
| A7002 |
Tubing, used with suction pump, each |
10,300 |
6,461 |
$48K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
6,962 |
6,772 |
$46K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,845 |
3,744 |
$38K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
879 |
544 |
$34K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,791 |
2,836 |
$34K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
5,877 |
4,157 |
$33K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,039 |
841 |
$32K |
| K0007 |
Extra heavy duty wheelchair |
649 |
625 |
$30K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
7,937 |
7,584 |
$26K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,087 |
4,910 |
$26K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
144 |
69 |
$25K |
| E1392 |
Portable oxygen concentrator, rental |
3,004 |
2,804 |
$23K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
7,542 |
6,953 |
$22K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
348 |
288 |
$21K |
| E0245 |
Tub stool or bench |
531 |
477 |
$20K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
126 |
124 |
$20K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
4,279 |
3,590 |
$16K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
506 |
304 |
$16K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,822 |
4,837 |
$15K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
198 |
162 |
$15K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
297 |
239 |
$14K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
453 |
383 |
$14K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
70 |
43 |
$11K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
217 |
209 |
$11K |
| E0776 |
Iv pole |
1,159 |
1,000 |
$11K |
| A4618 |
Breathing circuits |
653 |
380 |
$11K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,633 |
2,125 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
12,420 |
11,975 |
$9K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
129 |
121 |
$8K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
447 |
419 |
$7K |
| A7525 |
Tracheostomy mask, each |
3,744 |
2,915 |
$7K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
566 |
508 |
$7K |
| E0277 |
Powered pressure-reducing air mattress |
574 |
489 |
$5K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
30 |
24 |
$5K |
| L8501 |
Tracheostomy speaking valve |
58 |
49 |
$4K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
144 |
136 |
$4K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
119 |
115 |
$3K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
164 |
71 |
$3K |
| 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 |
17 |
12 |
$2K |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
395 |
335 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
14 |
12 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
125 |
119 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
400 |
386 |
$1K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
235 |
211 |
$946.81 |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
15 |
15 |
$761.25 |
| E0156 |
Seat attachment, walker |
459 |
441 |
$741.18 |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
51 |
49 |
$533.10 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
29 |
24 |
$420.47 |
| A4670 |
Automatic blood pressure monitor |
16 |
13 |
$387.27 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
37 |
24 |
$317.04 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
275 |
230 |
$295.33 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,681 |
1,622 |
$263.16 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
58 |
52 |
$154.81 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
14 |
12 |
$127.83 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
199 |
177 |
$100.00 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
34 |
30 |
$49.70 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
91 |
79 |
$19.68 |
| A4649 |
Surgical supply; miscellaneous |
274 |
234 |
$18.76 |
| E0274 |
Over-bed table |
14 |
13 |
$13.50 |
| A4217 |
Sterile water/saline, 500 ml |
131 |
86 |
$0.00 |