| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
906 |
835 |
$865K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,074 |
3,390 |
$639K |
| 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 |
1,720 |
1,516 |
$354K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,226 |
4,832 |
$189K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,344 |
1,312 |
$126K |
| B9998 |
Noc for enteral supplies |
2,157 |
2,046 |
$116K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
265 |
214 |
$78K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,543 |
2,888 |
$61K |
| 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 |
684 |
486 |
$41K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
517 |
481 |
$27K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
766 |
678 |
$11K |
| E0570 |
Nebulizer, with compressor |
2,676 |
1,909 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
120 |
114 |
$7K |
| E0601 |
Continuous positive airway pressure (cpap) device |
272 |
262 |
$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 |
64 |
61 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,029 |
713 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
327 |
256 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
313 |
285 |
$1K |
| E0776 |
Iv pole |
75 |
61 |
$469.76 |
| A7002 |
Tubing, used with suction pump, each |
277 |
214 |
$384.77 |
| A7031 |
Face mask interface, replacement for full face mask, each |
85 |
77 |
$289.56 |
| A7000 |
Canister, disposable, used with suction pump, each |
14 |
12 |
$104.46 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
226 |
196 |
$7.56 |
| A7035 |
Headgear used with positive airway pressure device |
27 |
24 |
$0.00 |
| A7030 |
Full face mask used with positive airway pressure device, each |
41 |
38 |
$0.00 |
| A7037 |
Tubing used with positive airway pressure device |
14 |
13 |
$0.00 |