| 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 |
6,385 |
4,926 |
$255K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,146 |
3,466 |
$144K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,452 |
1,943 |
$128K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
2,223 |
952 |
$102K |
| 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) |
979 |
828 |
$76K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
2,340 |
1,014 |
$63K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,207 |
4,292 |
$52K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,153 |
1,711 |
$51K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,795 |
2,862 |
$29K |
| E0570 |
Nebulizer, with compressor |
1,957 |
1,501 |
$27K |
| A7037 |
Tubing used with positive airway pressure device |
3,231 |
2,556 |
$27K |
| A7035 |
Headgear used with positive airway pressure device |
2,252 |
1,780 |
$24K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
474 |
398 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,521 |
2,779 |
$11K |
| E1392 |
Portable oxygen concentrator, rental |
341 |
323 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,782 |
1,396 |
$7K |
| E1130 |
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests |
269 |
261 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
693 |
563 |
$5K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
103 |
74 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
78 |
61 |
$844.25 |