| 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 |
2,001 |
1,838 |
$389K |
| 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 |
2,439 |
2,310 |
$381K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,322 |
7,441 |
$320K |
| 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 |
421 |
372 |
$218K |
| 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 |
1,050 |
691 |
$204K |
| 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 |
1,207 |
1,036 |
$147K |
| 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 |
1,225 |
1,069 |
$113K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
375 |
279 |
$73K |
| B9002 |
Enteral nutrition infusion pump, any type |
918 |
903 |
$68K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
523 |
483 |
$49K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,061 |
995 |
$35K |
| A7030 |
Full face mask used with positive airway pressure device, each |
387 |
350 |
$29K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
624 |
472 |
$27K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,359 |
3,058 |
$25K |
| E1392 |
Portable oxygen concentrator, rental |
2,305 |
1,998 |
$25K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
626 |
564 |
$15K |
| E0601 |
Continuous positive airway pressure (cpap) device |
267 |
264 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
565 |
554 |
$8K |
| E0776 |
Iv pole |
599 |
589 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,002 |
1,853 |
$7K |
| 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 |
48 |
38 |
$6K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
159 |
151 |
$5K |
| E0570 |
Nebulizer, with compressor |
743 |
659 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
254 |
233 |
$4K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
29 |
27 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
99 |
96 |
$986.28 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
41 |
37 |
$57.14 |