| 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 |
17,186 |
17,074 |
$1.21M |
| E0601 |
Continuous positive airway pressure (cpap) device |
10,282 |
10,195 |
$442K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,575 |
11,473 |
$167K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,728 |
2,626 |
$167K |
| 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) |
1,933 |
1,877 |
$158K |
| E0570 |
Nebulizer, with compressor |
4,533 |
4,415 |
$136K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
816 |
810 |
$98K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,322 |
1,302 |
$96K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,793 |
2,777 |
$92K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,197 |
2,150 |
$72K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,885 |
1,806 |
$72K |
| A7037 |
Tubing used with positive airway pressure device |
3,476 |
3,376 |
$65K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
340 |
335 |
$64K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,251 |
1,961 |
$62K |
| A7035 |
Headgear used with positive airway pressure device |
3,736 |
3,568 |
$59K |
| K0003 |
Lightweight wheelchair |
1,432 |
1,430 |
$40K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
485 |
470 |
$26K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,956 |
4,676 |
$26K |
| K0001 |
Standard wheelchair |
1,949 |
1,938 |
$25K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,912 |
1,889 |
$25K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
564 |
561 |
$24K |
| K0004 |
High strength, lightweight wheelchair |
214 |
213 |
$14K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
100 |
97 |
$13K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
426 |
364 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,952 |
1,914 |
$11K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
149 |
148 |
$8K |
| A4670 |
Automatic blood pressure monitor |
151 |
151 |
$7K |
| 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 |
108 |
94 |
$6K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
39 |
39 |
$6K |
| A4259 |
Lancets, per box of 100 |
1,374 |
1,352 |
$6K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
409 |
408 |
$3K |
| E0156 |
Seat attachment, walker |
375 |
374 |
$3K |
| 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 |
25 |
25 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
51 |
51 |
$3K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
153 |
151 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,585 |
1,555 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
223 |
222 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$1K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
96 |
95 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
89 |
24 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
34 |
26 |
$1K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 |
16 |
12 |
$946.71 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
606 |
575 |
$782.74 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
30 |
26 |
$778.83 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$767.37 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$703.45 |
| A7015 |
Aerosol mask, used with dme nebulizer |
646 |
633 |
$689.73 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
27 |
26 |
$379.82 |
| S5199 |
Personal care item, nos, each |
40 |
39 |
$295.20 |
| A4256 |
Normal, low and high calibrator solution / chips |
24 |
24 |
$83.57 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
13 |
13 |
$42.08 |