| 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 |
2,252 |
2,176 |
$596K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,144 |
4,007 |
$587K |
| 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 |
827 |
654 |
$581K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
908 |
845 |
$518K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,609 |
3,549 |
$464K |
| 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 |
3,078 |
3,007 |
$397K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,350 |
2,229 |
$308K |
| A4554 |
Disposable underpads, all sizes |
7,763 |
7,608 |
$242K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,127 |
2,084 |
$195K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,680 |
2,628 |
$179K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,473 |
2,413 |
$177K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,927 |
2,870 |
$172K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,499 |
1,457 |
$166K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
230 |
220 |
$160K |
| 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 |
558 |
510 |
$155K |
| 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 |
924 |
893 |
$129K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,092 |
1,069 |
$127K |
| 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) |
362 |
355 |
$126K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,187 |
1,161 |
$125K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,034 |
987 |
$107K |
| B9998 |
Noc for enteral supplies |
2,815 |
2,273 |
$100K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
900 |
881 |
$97K |
| E0570 |
Nebulizer, with compressor |
996 |
974 |
$83K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,687 |
3,583 |
$82K |
| A4927 |
Gloves, non-sterile, per 100 |
6,805 |
6,653 |
$81K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
418 |
410 |
$58K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
521 |
509 |
$56K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
569 |
538 |
$42K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
954 |
887 |
$22K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,856 |
3,777 |
$19K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,978 |
1,922 |
$16K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
191 |
175 |
$15K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
273 |
263 |
$13K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,132 |
1,084 |
$11K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
100 |
99 |
$10K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
864 |
851 |
$9K |
| K0001 |
Standard wheelchair |
244 |
221 |
$6K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
203 |
190 |
$4K |
| A7002 |
Tubing, used with suction pump, each |
1,964 |
1,891 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
238 |
223 |
$3K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
102 |
101 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,210 |
2,163 |
$2K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
379 |
351 |
$901.84 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
141 |
122 |
$588.68 |
| A7525 |
Tracheostomy mask, each |
182 |
170 |
$207.50 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
84 |
83 |
$182.39 |
| A7000 |
Canister, disposable, used with suction pump, each |
12 |
12 |
$64.90 |