| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,102 |
3,404 |
$586K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,811 |
1,399 |
$574K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,555 |
3,473 |
$369K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,804 |
9,547 |
$363K |
| 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 |
447 |
426 |
$297K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
888 |
693 |
$188K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,093 |
4,700 |
$146K |
| 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 |
586 |
561 |
$109K |
| B9998 |
Noc for enteral supplies |
1,643 |
1,555 |
$71K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
894 |
666 |
$38K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,585 |
1,301 |
$37K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,996 |
1,549 |
$31K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,631 |
1,556 |
$31K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,515 |
1,356 |
$26K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
522 |
500 |
$26K |
| B9002 |
Enteral nutrition infusion pump, any type |
346 |
318 |
$19K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
653 |
521 |
$19K |
| A4245 |
Alcohol wipes, per box |
474 |
384 |
$18K |
| E1392 |
Portable oxygen concentrator, rental |
2,233 |
1,608 |
$13K |
| 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 |
226 |
163 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
834 |
663 |
$9K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
251 |
223 |
$9K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
163 |
133 |
$8K |
| A7504 |
Filter for use in a tracheostoma heat and moisture exchange system, each |
565 |
496 |
$8K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,559 |
1,198 |
$8K |
| 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 |
303 |
262 |
$7K |
| E0570 |
Nebulizer, with compressor |
2,997 |
2,167 |
$7K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
38 |
24 |
$6K |
| A4605 |
Tracheal suction catheter, closed system, each |
158 |
111 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
894 |
608 |
$6K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
292 |
223 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,791 |
2,692 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
450 |
360 |
$5K |
| A4244 |
Alcohol or peroxide, per pint |
58 |
52 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
558 |
415 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
167 |
138 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
2,698 |
2,105 |
$3K |
| A7525 |
Tracheostomy mask, each |
829 |
647 |
$2K |
| E0776 |
Iv pole |
175 |
164 |
$2K |
| A4554 |
Disposable underpads, all sizes |
27 |
26 |
$1K |
| A4623 |
Tracheostomy, inner cannula |
57 |
38 |
$1K |
| 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 |
87 |
80 |
$1K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
41 |
41 |
$856.44 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,323 |
945 |
$682.88 |
| A4618 |
Breathing circuits |
48 |
40 |
$376.96 |
| A7037 |
Tubing used with positive airway pressure device |
291 |
246 |
$120.96 |
| A7030 |
Full face mask used with positive airway pressure device, each |
15 |
13 |
$26.62 |
| A7035 |
Headgear used with positive airway pressure device |
124 |
102 |
$24.55 |
| A7015 |
Aerosol mask, used with dme nebulizer |
59 |
51 |
$20.53 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
127 |
91 |
$15.90 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
44 |
38 |
$8.32 |