| 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 |
2,220 |
1,772 |
$93K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,233 |
1,003 |
$63K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,239 |
1,005 |
$45K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
298 |
207 |
$42K |
| A7030 |
Full face mask used with positive airway pressure device, each |
315 |
264 |
$20K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
562 |
437 |
$20K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
254 |
208 |
$18K |
| 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 |
51 |
40 |
$15K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
89 |
79 |
$14K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
19 |
13 |
$13K |
| B9002 |
Enteral nutrition infusion pump, any type |
212 |
183 |
$11K |
| 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 |
73 |
66 |
$11K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
82 |
72 |
$10K |
| E0570 |
Nebulizer, with compressor |
154 |
135 |
$10K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
221 |
192 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
170 |
144 |
$8K |
| E0619 |
Apnea monitor, with recording feature |
50 |
49 |
$8K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
84 |
75 |
$8K |
| 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) |
189 |
149 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
469 |
403 |
$7K |
| K0001 |
Standard wheelchair |
413 |
355 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
377 |
293 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
139 |
111 |
$5K |
| A7526 |
Tracheostomy tube collar/holder, each |
107 |
99 |
$4K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
33 |
32 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
141 |
136 |
$3K |
| A4605 |
Tracheal suction catheter, closed system, each |
34 |
33 |
$3K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
63 |
53 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
586 |
498 |
$3K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
112 |
109 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
181 |
181 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
61 |
59 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
95 |
95 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
316 |
267 |
$2K |
| K0003 |
Lightweight wheelchair |
32 |
26 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
196 |
176 |
$2K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
83 |
62 |
$1K |
| E0776 |
Iv pole |
75 |
68 |
$620.39 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
26 |
26 |
$613.77 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
73 |
64 |
$607.69 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
27 |
27 |
$605.09 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
44 |
33 |
$500.04 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
18 |
12 |
$403.51 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
27 |
27 |
$313.81 |
| A4217 |
Sterile water/saline, 500 ml |
64 |
58 |
$272.69 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
66 |
63 |
$171.97 |
| A7002 |
Tubing, used with suction pump, each |
55 |
53 |
$159.57 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
14 |
$155.82 |
| Z0020 |
|
43 |
38 |
$111.54 |
| S8189 |
Tracheostomy supply, not otherwise classified |
16 |
12 |
$95.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$48.93 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
40 |
37 |
$38.43 |