| 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 |
14,080 |
10,154 |
$738K |
| 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 |
6,592 |
5,745 |
$132K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,231 |
3,803 |
$130K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,445 |
2,012 |
$109K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
218 |
169 |
$103K |
| 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 |
1,661 |
879 |
$99K |
| A4554 |
Disposable underpads, all sizes |
1,861 |
1,713 |
$96K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
631 |
589 |
$89K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,245 |
591 |
$79K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,676 |
1,509 |
$69K |
| K0003 |
Lightweight wheelchair |
2,554 |
2,092 |
$60K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,521 |
759 |
$58K |
| A7030 |
Full face mask used with positive airway pressure device, each |
858 |
744 |
$55K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
433 |
409 |
$52K |
| E0570 |
Nebulizer, with compressor |
2,161 |
2,060 |
$46K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
300 |
278 |
$43K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,037 |
944 |
$43K |
| 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) |
602 |
413 |
$41K |
| A4623 |
Tracheostomy, inner cannula |
682 |
407 |
$36K |
| K0007 |
Extra heavy duty wheelchair |
450 |
359 |
$34K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,191 |
919 |
$31K |
| K0001 |
Standard wheelchair |
2,563 |
2,151 |
$29K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
235 |
196 |
$28K |
| E1392 |
Portable oxygen concentrator, rental |
1,405 |
1,215 |
$26K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,625 |
3,252 |
$24K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
686 |
614 |
$24K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
633 |
394 |
$23K |
| B9002 |
Enteral nutrition infusion pump, any type |
456 |
298 |
$20K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
38 |
24 |
$18K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
348 |
305 |
$18K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
187 |
172 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
1,053 |
922 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
673 |
594 |
$15K |
| A7031 |
Face mask interface, replacement for full face mask, each |
680 |
569 |
$14K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
239 |
213 |
$13K |
| K0006 |
Heavy duty wheelchair |
560 |
396 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
741 |
530 |
$13K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
495 |
396 |
$12K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
527 |
445 |
$11K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
130 |
119 |
$10K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
437 |
411 |
$9K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
60 |
52 |
$9K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
138 |
78 |
$9K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
93 |
69 |
$6K |
| A7526 |
Tracheostomy tube collar/holder, each |
639 |
400 |
$6K |
| E0277 |
Powered pressure-reducing air mattress |
44 |
24 |
$6K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
227 |
151 |
$6K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
639 |
489 |
$6K |
| E0156 |
Seat attachment, walker |
711 |
607 |
$5K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
45 |
24 |
$5K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
263 |
229 |
$5K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
593 |
508 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,507 |
1,195 |
$3K |
| 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 |
32 |
24 |
$3K |
| E2202 |
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
112 |
88 |
$3K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
132 |
119 |
$2K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
283 |
267 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
857 |
771 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
464 |
329 |
$1K |
| L8501 |
Tracheostomy speaking valve |
23 |
12 |
$900.81 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
74 |
66 |
$751.75 |
| A7015 |
Aerosol mask, used with dme nebulizer |
566 |
514 |
$654.39 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
79 |
75 |
$539.24 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
26 |
24 |
$483.49 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
204 |
170 |
$458.07 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
40 |
30 |
$436.14 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
103 |
75 |
$398.63 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
73 |
62 |
$345.97 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
559 |
513 |
$255.50 |
| A7012 |
Water collection device, used with large volume nebulizer |
49 |
26 |
$56.55 |
| A7525 |
Tracheostomy mask, each |
175 |
96 |
$38.98 |