| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
6,931 |
4,607 |
$3.08M |
| 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 |
5,060 |
3,212 |
$2.31M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,536 |
8,273 |
$1.32M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,127 |
1,388 |
$790K |
| 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 |
4,912 |
3,050 |
$767K |
| Y2032 |
|
2,981 |
2,187 |
$700K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
3,226 |
2,351 |
$655K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
4,332 |
1,776 |
$617K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,556 |
7,615 |
$571K |
| B9998 |
Noc for enteral supplies |
13,857 |
8,784 |
$524K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,172 |
2,097 |
$505K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,900 |
2,551 |
$475K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,481 |
3,212 |
$309K |
| T4541 |
Incontinence product, disposable underpad, large, each |
8,848 |
6,789 |
$246K |
| 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 |
1,015 |
693 |
$236K |
| A4217 |
Sterile water/saline, 500 ml |
5,813 |
3,654 |
$235K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
8,700 |
3,514 |
$191K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,271 |
1,693 |
$183K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,289 |
1,702 |
$176K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,879 |
4,443 |
$171K |
| A7526 |
Tracheostomy tube collar/holder, each |
5,227 |
3,409 |
$166K |
| A4927 |
Gloves, non-sterile, per 100 |
14,053 |
10,631 |
$160K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,204 |
1,734 |
$157K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,800 |
5,136 |
$153K |
| 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 |
419 |
304 |
$142K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,748 |
1,932 |
$141K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,798 |
1,295 |
$139K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,532 |
1,245 |
$122K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,882 |
2,839 |
$115K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,426 |
4,511 |
$113K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,980 |
1,833 |
$109K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,131 |
789 |
$86K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
858 |
715 |
$75K |
| 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 |
721 |
438 |
$71K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,575 |
1,201 |
$71K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,760 |
1,534 |
$70K |
| 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 |
690 |
476 |
$68K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
686 |
612 |
$56K |
| A7002 |
Tubing, used with suction pump, each |
6,340 |
4,495 |
$50K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
513 |
414 |
$49K |
| 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) |
705 |
591 |
$48K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
630 |
612 |
$46K |
| A7000 |
Canister, disposable, used with suction pump, each |
6,576 |
4,691 |
$46K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,821 |
1,572 |
$44K |
| E0570 |
Nebulizer, with compressor |
1,397 |
1,125 |
$43K |
| 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 |
1,457 |
879 |
$41K |
| A7035 |
Headgear used with positive airway pressure device |
2,835 |
2,455 |
$36K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
211 |
127 |
$36K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,346 |
1,979 |
$31K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,784 |
2,082 |
$30K |
| E1399 |
Durable medical equipment, miscellaneous |
1,203 |
771 |
$30K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
457 |
372 |
$28K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,763 |
1,500 |
$26K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
279 |
213 |
$25K |
| A7037 |
Tubing used with positive airway pressure device |
2,249 |
1,733 |
$25K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,188 |
789 |
$24K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
325 |
262 |
$22K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
141 |
106 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,952 |
8,112 |
$21K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
975 |
809 |
$20K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,043 |
752 |
$19K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
67 |
57 |
$18K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,023 |
2,170 |
$16K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,465 |
3,204 |
$14K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
7,539 |
5,659 |
$13K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,137 |
1,505 |
$12K |
| E0619 |
Apnea monitor, with recording feature |
58 |
52 |
$12K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
966 |
845 |
$12K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,768 |
1,545 |
$10K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
370 |
299 |
$8K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
154 |
90 |
$7K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
75 |
64 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,809 |
2,226 |
$5K |
| A4930 |
Gloves, sterile, per pair |
182 |
124 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,549 |
1,347 |
$5K |
| A4618 |
Breathing circuits |
2,349 |
1,783 |
$5K |
| A7525 |
Tracheostomy mask, each |
2,679 |
1,072 |
$4K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
790 |
336 |
$4K |
| E0776 |
Iv pole |
295 |
266 |
$3K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
79 |
65 |
$3K |
| A4402 |
Lubricant, per ounce |
1,685 |
1,346 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
33 |
27 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
740 |
348 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
33 |
24 |
$1K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
34 |
26 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
125 |
95 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
39 |
36 |
$690.22 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
221 |
150 |
$679.21 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
97 |
75 |
$391.05 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
27 |
14 |
$154.49 |
| A4616 |
Tubing (oxygen), per foot |
208 |
132 |
$139.92 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
24 |
12 |
$131.29 |
| E1353 |
Regulator |
1,298 |
1,006 |
$62.81 |
| A4657 |
Syringe, with or without needle, each |
1,574 |
1,107 |
$50.65 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
187 |
162 |
$2.57 |
| A4615 |
Cannula, nasal |
66 |
52 |
$1.33 |
| A4245 |
Alcohol wipes, per box |
181 |
157 |
$0.28 |
| A4554 |
Disposable underpads, all sizes |
58 |
51 |
$0.00 |
| A9270 |
Non-covered item or service |
30 |
26 |
$0.00 |