| 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 |
4,110 |
3,505 |
$3.01M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
10,888 |
10,225 |
$2.23M |
| 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 |
8,532 |
7,917 |
$1.99M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,752 |
2,377 |
$1.61M |
| 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 |
1,873 |
1,545 |
$1.43M |
| B9002 |
Enteral nutrition infusion pump, any type |
14,945 |
13,859 |
$1.19M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,654 |
7,573 |
$1.06M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,624 |
1,370 |
$926K |
| 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 |
2,093 |
1,928 |
$903K |
| A4554 |
Disposable underpads, all sizes |
12,291 |
11,182 |
$894K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,939 |
3,327 |
$734K |
| 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 |
3,557 |
2,909 |
$551K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,090 |
8,157 |
$531K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,942 |
3,665 |
$516K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,209 |
4,627 |
$512K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,416 |
4,945 |
$494K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
6,670 |
6,330 |
$494K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
9,703 |
8,172 |
$439K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,283 |
3,871 |
$415K |
| A4927 |
Gloves, non-sterile, per 100 |
15,586 |
13,843 |
$301K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,203 |
1,960 |
$272K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
4,529 |
4,013 |
$249K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,473 |
2,028 |
$238K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,783 |
1,585 |
$193K |
| 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 |
882 |
767 |
$178K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,275 |
1,964 |
$166K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,697 |
1,598 |
$147K |
| A4244 |
Alcohol or peroxide, per pint |
2,858 |
2,567 |
$126K |
| B9998 |
Noc for enteral supplies |
3,094 |
2,787 |
$125K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,560 |
4,428 |
$122K |
| S5199 |
Personal care item, nos, each |
1,303 |
764 |
$113K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
977 |
946 |
$109K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
10,755 |
6,596 |
$109K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,178 |
1,109 |
$107K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
814 |
729 |
$96K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
1,791 |
1,555 |
$92K |
| A4245 |
Alcohol wipes, per box |
2,451 |
2,213 |
$87K |
| A7002 |
Tubing, used with suction pump, each |
6,405 |
5,643 |
$84K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
3,439 |
2,925 |
$81K |
| 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 |
1,090 |
990 |
$79K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,456 |
1,226 |
$78K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,881 |
2,524 |
$71K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
4,184 |
3,242 |
$69K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,819 |
3,349 |
$58K |
| A4402 |
Lubricant, per ounce |
1,414 |
1,273 |
$44K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
348 |
327 |
$43K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,065 |
892 |
$41K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
1,081 |
838 |
$39K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
168 |
149 |
$34K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
243 |
232 |
$33K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
896 |
792 |
$33K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
435 |
393 |
$31K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,461 |
1,258 |
$30K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
195 |
187 |
$28K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
584 |
525 |
$24K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
242 |
229 |
$22K |
| E0618 |
Apnea monitor, without recording feature |
207 |
145 |
$21K |
| E1399 |
Durable medical equipment, miscellaneous |
143 |
103 |
$18K |
| A4930 |
Gloves, sterile, per pair |
892 |
809 |
$15K |
| E0570 |
Nebulizer, with compressor |
183 |
163 |
$12K |
| A7525 |
Tracheostomy mask, each |
4,333 |
2,019 |
$12K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,039 |
3,907 |
$11K |
| E0776 |
Iv pole |
1,002 |
971 |
$10K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
14 |
12 |
$10K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,275 |
1,067 |
$8K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,954 |
931 |
$7K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
261 |
222 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
935 |
838 |
$7K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
142 |
137 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
61 |
43 |
$4K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
30 |
28 |
$3K |
| 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 |
12 |
12 |
$3K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
58 |
39 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
28 |
25 |
$92.00 |