| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,553 |
3,035 |
$487K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,525 |
6,948 |
$329K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,022 |
953 |
$184K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,257 |
2,900 |
$182K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,616 |
4,203 |
$120K |
| 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 |
790 |
661 |
$118K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,329 |
887 |
$115K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,204 |
3,778 |
$97K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,947 |
1,731 |
$72K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,851 |
4,248 |
$60K |
| 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 |
217 |
168 |
$59K |
| A7037 |
Tubing used with positive airway pressure device |
5,044 |
4,430 |
$58K |
| A7035 |
Headgear used with positive airway pressure device |
3,640 |
3,253 |
$49K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,692 |
4,823 |
$47K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
659 |
568 |
$39K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,961 |
3,618 |
$33K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,990 |
7,931 |
$30K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,595 |
1,464 |
$25K |
| E0570 |
Nebulizer, with compressor |
3,239 |
1,899 |
$24K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
206 |
181 |
$14K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,198 |
1,064 |
$14K |
| K0001 |
Standard wheelchair |
1,458 |
940 |
$13K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,840 |
1,623 |
$7K |
| 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 |
58 |
53 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
313 |
233 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
220 |
161 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
291 |
270 |
$4K |
| 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 |
32 |
25 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
60 |
51 |
$2K |
| E0776 |
Iv pole |
460 |
339 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
54 |
53 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
103 |
79 |
$871.05 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
29 |
24 |
$258.86 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
350 |
302 |
$225.09 |
| A7036 |
Chinstrap used with positive airway pressure device |
14 |
14 |
$87.22 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
119 |
92 |
$48.60 |