| 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 |
9,198 |
6,920 |
$148K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,655 |
3,729 |
$136K |
| 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 |
4,197 |
2,721 |
$107K |
| 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 |
670 |
645 |
$90K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,979 |
4,683 |
$52K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,596 |
1,109 |
$50K |
| 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 |
1,547 |
1,068 |
$48K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
591 |
372 |
$39K |
| 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 |
1,670 |
1,021 |
$26K |
| E0601 |
Continuous positive airway pressure (cpap) device |
774 |
732 |
$16K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,172 |
753 |
$14K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
684 |
636 |
$4K |
| E0570 |
Nebulizer, with compressor |
2,174 |
1,779 |
$3K |
| E0776 |
Iv pole |
1,617 |
1,206 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
344 |
248 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
154 |
127 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
278 |
225 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,787 |
1,454 |
$719.24 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
236 |
187 |
$579.78 |
| A7037 |
Tubing used with positive airway pressure device |
591 |
478 |
$421.55 |
| A7035 |
Headgear used with positive airway pressure device |
364 |
303 |
$248.43 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
481 |
381 |
$177.86 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
174 |
89 |
$160.92 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
157 |
134 |
$83.53 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
20 |
12 |
$35.36 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
73 |
38 |
$16.78 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
48 |
41 |
$0.33 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
97 |
92 |
$0.00 |