| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
9,663 |
9,457 |
$3.63M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
12,335 |
12,289 |
$2.80M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
3,486 |
3,485 |
$2.26M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,349 |
12,310 |
$387K |
| A4554 |
Disposable underpads, all sizes |
10,409 |
9,211 |
$317K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,984 |
2,245 |
$236K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
2,293 |
1,259 |
$201K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,940 |
2,905 |
$195K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
752 |
752 |
$158K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
5,919 |
5,898 |
$155K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,875 |
1,869 |
$141K |
| E0575 |
Nebulizer, ultrasonic, large volume |
361 |
346 |
$123K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,327 |
2,287 |
$118K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
1,287 |
745 |
$104K |
| E0570 |
Nebulizer, with compressor |
1,273 |
1,263 |
$90K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,775 |
2,763 |
$84K |
| E0601 |
Continuous positive airway pressure (cpap) device |
765 |
758 |
$63K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
169 |
165 |
$49K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
94 |
94 |
$43K |
| 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 |
1,164 |
735 |
$38K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
685 |
468 |
$35K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
1,131 |
1,072 |
$30K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
571 |
317 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
7,776 |
7,546 |
$27K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
432 |
302 |
$26K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
990 |
640 |
$23K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
403 |
263 |
$22K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,565 |
1,487 |
$19K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
665 |
659 |
$15K |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
221 |
125 |
$12K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
281 |
281 |
$12K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
95 |
95 |
$10K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
406 |
204 |
$7K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
102 |
57 |
$4K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
81 |
49 |
$4K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
24 |
24 |
$4K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
154 |
154 |
$3K |
| K0001 |
Standard wheelchair |
332 |
328 |
$3K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
23 |
23 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
198 |
196 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
249 |
248 |
$2K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
23 |
12 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
67 |
67 |
$1K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
12 |
12 |
$737.31 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
295 |
294 |
$609.66 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
259 |
258 |
$574.41 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
25 |
25 |
$441.91 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$384.67 |
| A7015 |
Aerosol mask, used with dme nebulizer |
210 |
210 |
$172.62 |
| E0156 |
Seat attachment, walker |
25 |
25 |
$121.70 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
40 |
40 |
$77.21 |
| A4402 |
Lubricant, per ounce |
12 |
12 |
$29.42 |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
12 |
12 |
$0.00 |