| 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 |
6,944 |
5,100 |
$1.63M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,618 |
1,496 |
$1.58M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
20,858 |
17,712 |
$1.32M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
15,758 |
13,416 |
$800K |
| 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 |
1,566 |
1,332 |
$306K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,327 |
1,254 |
$305K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,648 |
2,189 |
$194K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,400 |
3,790 |
$173K |
| K0001 |
Standard wheelchair |
6,820 |
6,005 |
$152K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,698 |
1,369 |
$139K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,256 |
954 |
$134K |
| E0570 |
Nebulizer, with compressor |
3,581 |
3,445 |
$119K |
| B9998 |
Noc for enteral supplies |
4,799 |
3,069 |
$104K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,364 |
2,387 |
$92K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,355 |
2,123 |
$87K |
| 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 |
509 |
417 |
$84K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,400 |
1,105 |
$82K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,953 |
1,663 |
$79K |
| A4217 |
Sterile water/saline, 500 ml |
2,116 |
1,246 |
$66K |
| 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 |
112 |
102 |
$59K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
4,892 |
4,335 |
$59K |
| 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 |
376 |
290 |
$53K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,144 |
1,409 |
$51K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,892 |
1,646 |
$50K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,422 |
2,008 |
$49K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,477 |
2,013 |
$48K |
| A7035 |
Headgear used with positive airway pressure device |
1,970 |
1,697 |
$42K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,172 |
914 |
$36K |
| 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) |
607 |
457 |
$31K |
| 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 |
39 |
37 |
$30K |
| A4605 |
Tracheal suction catheter, closed system, each |
287 |
198 |
$25K |
| E0776 |
Iv pole |
1,701 |
1,547 |
$25K |
| E1399 |
Durable medical equipment, miscellaneous |
217 |
125 |
$23K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,779 |
1,908 |
$22K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
325 |
275 |
$20K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
208 |
197 |
$18K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,130 |
907 |
$18K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,625 |
2,048 |
$17K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
446 |
344 |
$16K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
286 |
239 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,340 |
2,650 |
$14K |
| A7002 |
Tubing, used with suction pump, each |
3,272 |
2,419 |
$13K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
615 |
506 |
$13K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
268 |
256 |
$10K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
91 |
64 |
$8K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
557 |
424 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,679 |
2,377 |
$7K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
135 |
102 |
$6K |
| K0006 |
Heavy duty wheelchair |
360 |
301 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
825 |
484 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
99 |
80 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,049 |
689 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
52 |
52 |
$2K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
590 |
460 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
194 |
168 |
$1K |
| K0003 |
Lightweight wheelchair |
78 |
64 |
$827.92 |
| Z0020 |
|
227 |
214 |
$808.92 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
23 |
13 |
$736.98 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$465.79 |
| A4927 |
Gloves, non-sterile, per 100 |
87 |
63 |
$422.37 |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
16 |
13 |
$350.02 |
| E1392 |
Portable oxygen concentrator, rental |
413 |
379 |
$348.84 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
14 |
13 |
$266.28 |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
12 |
12 |
$258.06 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
385 |
209 |
$174.35 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
13 |
12 |
$163.69 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
31 |
24 |
$147.28 |
| A4649 |
Surgical supply; miscellaneous |
29 |
27 |
$96.50 |
| E1355 |
Stand/rack |
108 |
104 |
$65.34 |
| A7015 |
Aerosol mask, used with dme nebulizer |
47 |
40 |
$2.91 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
63 |
22 |
$0.00 |