| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,783 |
1,287 |
$1.09M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
13,518 |
10,331 |
$593K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,845 |
4,696 |
$492K |
| E0601 |
Continuous positive airway pressure (cpap) device |
11,623 |
9,543 |
$452K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,747 |
2,423 |
$363K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,632 |
4,534 |
$283K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
10,799 |
8,683 |
$260K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,429 |
5,119 |
$224K |
| A7031 |
Face mask interface, replacement for full face mask, each |
5,165 |
4,089 |
$181K |
| A7035 |
Headgear used with positive airway pressure device |
9,103 |
7,459 |
$179K |
| A7037 |
Tubing used with positive airway pressure device |
7,332 |
6,193 |
$157K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,264 |
830 |
$70K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
11,684 |
9,347 |
$58K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
101 |
85 |
$48K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,784 |
938 |
$48K |
| E0570 |
Nebulizer, with compressor |
4,693 |
3,801 |
$46K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,920 |
2,314 |
$45K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
7,048 |
5,405 |
$43K |
| 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) |
793 |
647 |
$41K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,523 |
1,063 |
$38K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,760 |
1,390 |
$30K |
| K0001 |
Standard wheelchair |
3,403 |
2,632 |
$29K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,459 |
1,088 |
$26K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
231 |
157 |
$24K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
681 |
455 |
$23K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,144 |
1,326 |
$22K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,497 |
2,725 |
$21K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
821 |
312 |
$21K |
| 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 |
3,620 |
2,945 |
$21K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,165 |
879 |
$20K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,500 |
1,087 |
$20K |
| A4927 |
Gloves, non-sterile, per 100 |
2,652 |
1,463 |
$18K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
570 |
379 |
$15K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
266 |
222 |
$10K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
843 |
642 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,661 |
1,344 |
$8K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
440 |
314 |
$8K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,956 |
1,506 |
$7K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
916 |
562 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,740 |
1,259 |
$6K |
| A4618 |
Breathing circuits |
626 |
449 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,191 |
2,127 |
$6K |
| E0156 |
Seat attachment, walker |
815 |
583 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,023 |
1,540 |
$6K |
| E0245 |
Tub stool or bench |
139 |
115 |
$5K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
358 |
233 |
$5K |
| A4670 |
Automatic blood pressure monitor |
81 |
81 |
$5K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
186 |
139 |
$4K |
| 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) |
15 |
12 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
97 |
77 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
593 |
430 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
429 |
316 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
782 |
572 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
351 |
234 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
53 |
37 |
$2K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
73 |
61 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
115 |
76 |
$2K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
199 |
86 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
22 |
13 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
272 |
200 |
$1K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
61 |
37 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
86 |
73 |
$599.77 |
| 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 |
202 |
106 |
$573.49 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
78 |
44 |
$521.19 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
14 |
13 |
$473.76 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
340 |
253 |
$388.05 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
286 |
117 |
$380.00 |
| K0007 |
Extra heavy duty wheelchair |
13 |
12 |
$282.94 |
| K0003 |
Lightweight wheelchair |
41 |
24 |
$260.75 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
225 |
158 |
$227.99 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
17 |
14 |
$202.39 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
24 |
12 |
$156.99 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
15 |
13 |
$150.98 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
17 |
12 |
$130.26 |
| A7015 |
Aerosol mask, used with dme nebulizer |
41 |
29 |
$36.31 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
16 |
12 |
$29.69 |
| A4371 |
Ostomy skin barrier, powder, per oz |
20 |
14 |
$26.59 |
| A4626 |
Tracheostomy cleaning brush, each |
18 |
12 |
$14.82 |