| 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 |
56,073 |
44,317 |
$2.70M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
4,769 |
3,407 |
$2.56M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,124 |
9,329 |
$900K |
| E0601 |
Continuous positive airway pressure (cpap) device |
25,026 |
19,073 |
$639K |
| E0430 |
Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,247 |
14,397 |
$535K |
| E1170 |
Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests |
997 |
834 |
$484K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,126 |
1,669 |
$458K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,630 |
7,377 |
$455K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
7,141 |
5,933 |
$394K |
| E1260 |
Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest |
532 |
461 |
$337K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,488 |
1,955 |
$301K |
| 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) |
4,854 |
3,606 |
$282K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,010 |
821 |
$280K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
10,663 |
8,526 |
$198K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,977 |
3,390 |
$158K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,598 |
1,423 |
$154K |
| E0570 |
Nebulizer, with compressor |
9,648 |
8,440 |
$138K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
2,408 |
1,711 |
$129K |
| K0002 |
Standard hemi (low seat) wheelchair |
9,093 |
7,462 |
$120K |
| E1090 |
High strength lightweight wheelchair, detachable arms desk or full length, swing away detachable foot rests |
154 |
137 |
$108K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,119 |
1,679 |
$107K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,009 |
891 |
$102K |
| A4554 |
Disposable underpads, all sizes |
3,039 |
2,697 |
$100K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,553 |
3,276 |
$99K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
601 |
512 |
$99K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
690 |
585 |
$99K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
6,140 |
3,260 |
$95K |
| K0003 |
Lightweight wheelchair |
5,645 |
4,625 |
$82K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,213 |
2,624 |
$81K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
3,295 |
2,538 |
$71K |
| 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 |
495 |
372 |
$69K |
| A4927 |
Gloves, non-sterile, per 100 |
7,143 |
5,763 |
$66K |
| 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 |
1,059 |
761 |
$64K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
22,015 |
20,778 |
$55K |
| E0184 |
Dry pressure mattress |
1,647 |
1,225 |
$54K |
| 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 |
936 |
667 |
$52K |
| K0007 |
Extra heavy duty wheelchair |
2,162 |
1,672 |
$50K |
| B4100 |
Food thickener, administered orally, per ounce |
452 |
374 |
$48K |
| K0006 |
Heavy duty wheelchair |
2,056 |
1,664 |
$44K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,536 |
2,168 |
$44K |
| K0001 |
Standard wheelchair |
7,340 |
5,827 |
$43K |
| E0245 |
Tub stool or bench |
580 |
515 |
$40K |
| A7031 |
Face mask interface, replacement for full face mask, each |
6,220 |
3,489 |
$39K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,474 |
1,104 |
$37K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,474 |
1,787 |
$36K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
213 |
159 |
$31K |
| B9998 |
Noc for enteral supplies |
915 |
699 |
$30K |
| E0277 |
Powered pressure-reducing air mattress |
483 |
360 |
$30K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
842 |
651 |
$28K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
8,212 |
4,275 |
$28K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,693 |
920 |
$27K |
| 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 |
383 |
277 |
$24K |
| A7037 |
Tubing used with positive airway pressure device |
5,371 |
3,894 |
$23K |
| E0156 |
Seat attachment, walker |
3,069 |
2,517 |
$22K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
357 |
255 |
$20K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,075 |
1,153 |
$19K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
2,887 |
2,385 |
$16K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,299 |
1,202 |
$16K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
62 |
44 |
$16K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
249 |
165 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,303 |
4,572 |
$14K |
| A7035 |
Headgear used with positive airway pressure device |
6,781 |
5,000 |
$14K |
| 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 |
118 |
94 |
$13K |
| E0246 |
Transfer tub rail attachment |
179 |
149 |
$10K |
| E0241 |
Bath tub wall rail, each |
306 |
247 |
$10K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,260 |
907 |
$9K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
403 |
261 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
179 |
136 |
$6K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
545 |
409 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,419 |
1,722 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,786 |
2,172 |
$5K |
| 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 |
364 |
290 |
$5K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
106 |
76 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
941 |
792 |
$4K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
98 |
83 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,075 |
783 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
345 |
177 |
$2K |
| E0141 |
Walker, rigid, wheeled, adjustable or fixed height |
95 |
85 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
237 |
167 |
$875.87 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
15 |
12 |
$776.65 |
| A4322 |
Irrigation syringe, bulb or piston, each |
104 |
87 |
$628.86 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
268 |
208 |
$593.61 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,619 |
1,347 |
$473.81 |
| A7000 |
Canister, disposable, used with suction pump, each |
21 |
12 |
$348.90 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
58 |
52 |
$257.47 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
17 |
13 |
$186.77 |
| E0305 |
Bed side rails, half length |
16 |
15 |
$18.00 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
30 |
24 |
$4.76 |