| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,025 |
4,753 |
$1.67M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
52,103 |
50,146 |
$715K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,831 |
1,796 |
$567K |
| T4541 |
Incontinence product, disposable underpad, large, each |
75,043 |
72,870 |
$337K |
| 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) |
1,940 |
1,930 |
$240K |
| E0601 |
Continuous positive airway pressure (cpap) device |
38,580 |
38,346 |
$235K |
| E0277 |
Powered pressure-reducing air mattress |
4,441 |
4,325 |
$223K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
33,994 |
33,288 |
$209K |
| 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) |
7,578 |
7,532 |
$195K |
| K0001 |
Standard wheelchair |
34,583 |
34,199 |
$188K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
23,102 |
22,554 |
$170K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,567 |
13,255 |
$162K |
| 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 |
1,299 |
1,228 |
$149K |
| A4670 |
Automatic blood pressure monitor |
9,415 |
7,862 |
$148K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
29,233 |
27,683 |
$133K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
54,303 |
53,952 |
$133K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
50,970 |
48,604 |
$126K |
| 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 |
11,056 |
9,954 |
$119K |
| 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 |
2,776 |
2,338 |
$109K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
10,607 |
10,568 |
$101K |
| 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 |
1,534 |
1,481 |
$94K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
9,517 |
9,356 |
$85K |
| E0570 |
Nebulizer, with compressor |
7,581 |
7,472 |
$83K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
9,821 |
9,723 |
$77K |
| E1399 |
Durable medical equipment, miscellaneous |
507 |
433 |
$74K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
9,051 |
8,806 |
$70K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
11,146 |
10,880 |
$66K |
| 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 |
6,562 |
5,745 |
$64K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
608 |
602 |
$64K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,546 |
2,519 |
$55K |
| K0006 |
Heavy duty wheelchair |
4,913 |
4,906 |
$54K |
| 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 |
883 |
875 |
$48K |
| K0003 |
Lightweight wheelchair |
5,866 |
5,811 |
$43K |
| K0007 |
Extra heavy duty wheelchair |
2,157 |
2,133 |
$42K |
| A7035 |
Headgear used with positive airway pressure device |
12,495 |
12,394 |
$38K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,987 |
12,622 |
$38K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,249 |
3,080 |
$36K |
| E0245 |
Tub stool or bench |
6,655 |
6,605 |
$36K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,989 |
6,807 |
$34K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,310 |
4,292 |
$33K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,275 |
3,231 |
$31K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,770 |
3,707 |
$29K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
162 |
162 |
$28K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,669 |
3,635 |
$28K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
2,663 |
2,640 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,426 |
1,388 |
$23K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
3,511 |
3,436 |
$22K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
10,913 |
10,715 |
$22K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
2,600 |
1,132 |
$20K |
| E0156 |
Seat attachment, walker |
5,707 |
5,639 |
$19K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,893 |
2,859 |
$18K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,792 |
1,718 |
$18K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
4,301 |
3,881 |
$17K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,709 |
3,443 |
$17K |
| A4663 |
Blood pressure cuff only |
1,435 |
1,408 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
8,020 |
7,941 |
$16K |
| 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 |
4,213 |
4,107 |
$15K |
| E0305 |
Bed side rails, half length |
8,164 |
8,064 |
$15K |
| E0272 |
Mattress, foam rubber |
7,344 |
7,279 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,008 |
1,979 |
$14K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,950 |
3,783 |
$14K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
8,818 |
8,776 |
$12K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
2,855 |
2,836 |
$11K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,363 |
1,315 |
$11K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,976 |
1,813 |
$11K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
65 |
65 |
$11K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
1,475 |
1,452 |
$10K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
94 |
72 |
$9K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
387 |
358 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,081 |
8,953 |
$8K |
| E0271 |
Mattress, innerspring |
2,174 |
2,141 |
$8K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,581 |
1,472 |
$8K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
595 |
589 |
$8K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,856 |
4,727 |
$7K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,415 |
1,373 |
$7K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,059 |
2,019 |
$6K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,685 |
1,630 |
$6K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
468 |
284 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,868 |
2,842 |
$6K |
| E0310 |
Bed side rails, full length |
3,239 |
3,201 |
$5K |
| 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 |
256 |
239 |
$5K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,016 |
3,227 |
$5K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
2,118 |
2,108 |
$5K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
489 |
364 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
6,421 |
6,114 |
$4K |
| A7031 |
Face mask interface, replacement for full face mask, each |
598 |
594 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,284 |
3,170 |
$4K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
9,673 |
9,486 |
$4K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,816 |
1,774 |
$4K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
220 |
210 |
$4K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
34 |
24 |
$4K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,075 |
1,765 |
$3K |
| E0297 |
Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress |
71 |
66 |
$3K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
274 |
262 |
$3K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
1,447 |
1,446 |
$3K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
68 |
64 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
202 |
200 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,135 |
1,118 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,235 |
1,226 |
$2K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
327 |
319 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,846 |
2,821 |
$2K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
918 |
913 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,634 |
6,020 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,271 |
1,256 |
$2K |
| K0004 |
High strength, lightweight wheelchair |
161 |
161 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
544 |
544 |
$2K |
| 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 |
12 |
12 |
$2K |
| 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 |
976 |
945 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,302 |
2,102 |
$2K |
| E0776 |
Iv pole |
1,298 |
1,284 |
$2K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
199 |
199 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,561 |
2,449 |
$2K |
| E0244 |
Raised toilet seat |
474 |
471 |
$2K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
25 |
25 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,550 |
2,443 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
392 |
387 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
110 |
106 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
759 |
729 |
$1K |
| A7526 |
Tracheostomy tube collar/holder, each |
317 |
294 |
$1K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
163 |
161 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,394 |
3,274 |
$1K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
199 |
195 |
$903.64 |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
20 |
12 |
$886.90 |
| B9998 |
Noc for enteral supplies |
2,476 |
2,081 |
$846.21 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
91 |
91 |
$773.83 |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
19 |
19 |
$768.93 |
| A4623 |
Tracheostomy, inner cannula |
93 |
88 |
$676.32 |
| A7002 |
Tubing, used with suction pump, each |
738 |
715 |
$675.25 |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
27 |
27 |
$667.89 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
5,159 |
5,046 |
$651.38 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
65 |
65 |
$615.45 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
909 |
900 |
$579.13 |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
558 |
536 |
$486.77 |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
244 |
233 |
$434.34 |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
36 |
36 |
$355.65 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
477 |
467 |
$354.54 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
405 |
396 |
$337.81 |
| A4402 |
Lubricant, per ounce |
1,522 |
1,464 |
$316.98 |
| E0246 |
Transfer tub rail attachment |
58 |
57 |
$296.64 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
502 |
491 |
$265.94 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
474 |
308 |
$262.68 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
401 |
388 |
$259.90 |
| A4371 |
Ostomy skin barrier, powder, per oz |
815 |
784 |
$213.41 |
| E0241 |
Bath tub wall rail, each |
30 |
25 |
$201.10 |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
13 |
12 |
$190.45 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
144 |
144 |
$169.53 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
309 |
291 |
$144.73 |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
200 |
196 |
$144.51 |
| 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 |
903 |
856 |
$134.13 |
| A4335 |
Incontinence supply; miscellaneous |
6,209 |
6,029 |
$117.27 |
| A7015 |
Aerosol mask, used with dme nebulizer |
397 |
387 |
$113.99 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
97 |
97 |
$104.09 |
| K0733 |
Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
14 |
14 |
$90.47 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
225 |
215 |
$65.06 |
| E1356 |
Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each |
745 |
686 |
$65.00 |
| A4615 |
Cannula, nasal |
4,601 |
4,262 |
$64.82 |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
26 |
25 |
$56.52 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
486 |
467 |
$49.09 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
12 |
12 |
$45.50 |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
1,029 |
1,019 |
$44.75 |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
68 |
68 |
$40.22 |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
1,224 |
1,224 |
$38.08 |
| A4367 |
Ostomy belt, each |
105 |
103 |
$35.68 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
568 |
560 |
$34.34 |
| A6260 |
Wound cleansers, any type, any size |
429 |
420 |
$31.19 |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
14 |
12 |
$22.07 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
69 |
65 |
$19.02 |
| E0441 |
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
17 |
13 |
$15.09 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
125 |
122 |
$5.30 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
132 |
106 |
$2.00 |
| 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 |
295 |
294 |
$0.00 |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
178 |
177 |
$0.00 |
| 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 |
57 |
57 |
$0.00 |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$0.00 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
16 |
16 |
$0.00 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
682 |
648 |
$0.00 |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
259 |
167 |
$0.00 |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
12 |
12 |
$0.00 |
| 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 |
13 |
12 |
$0.00 |