| 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 |
5,899 |
5,166 |
$1.06M |
| 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 |
1,322 |
1,146 |
$1.00M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,956 |
12,035 |
$741K |
| 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 |
1,463 |
1,272 |
$500K |
| 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 |
2,783 |
2,428 |
$317K |
| 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 |
730 |
625 |
$263K |
| 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 |
2,377 |
2,180 |
$230K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,451 |
2,166 |
$158K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,354 |
1,210 |
$126K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,006 |
920 |
$121K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,248 |
3,086 |
$100K |
| 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 |
696 |
651 |
$88K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,133 |
1,031 |
$71K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,692 |
1,645 |
$70K |
| E1392 |
Portable oxygen concentrator, rental |
4,682 |
4,238 |
$66K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,668 |
4,456 |
$53K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,584 |
1,533 |
$43K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,227 |
2,148 |
$41K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,031 |
991 |
$39K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,621 |
1,571 |
$38K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,953 |
1,862 |
$35K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
117 |
106 |
$25K |
| B9998 |
Noc for enteral supplies |
624 |
552 |
$23K |
| A7035 |
Headgear used with positive airway pressure device |
2,125 |
2,060 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,234 |
4,987 |
$20K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
691 |
658 |
$18K |
| E0570 |
Nebulizer, with compressor |
3,626 |
3,593 |
$17K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,793 |
1,725 |
$11K |
| 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 |
302 |
255 |
$9K |
| E0776 |
Iv pole |
1,997 |
1,901 |
$9K |
| A7037 |
Tubing used with positive airway pressure device |
1,238 |
1,197 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,623 |
1,517 |
$2K |
| 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) |
12 |
12 |
$364.91 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
41 |
41 |
$249.16 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
77 |
76 |
$130.62 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
15 |
15 |
$2.80 |