| 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 |
31,435 |
21,828 |
$1.19M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,352 |
1,422 |
$601K |
| 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 |
1,711 |
1,034 |
$510K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,796 |
1,609 |
$503K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,197 |
2,658 |
$236K |
| 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 |
1,650 |
1,081 |
$195K |
| E0430 |
Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,855 |
2,809 |
$154K |
| 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 |
477 |
331 |
$140K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
5,111 |
3,072 |
$132K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
327 |
119 |
$129K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,595 |
2,187 |
$67K |
| 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 |
549 |
373 |
$64K |
| B4100 |
Food thickener, administered orally, per ounce |
1,070 |
692 |
$58K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
170 |
111 |
$47K |
| B9998 |
Noc for enteral supplies |
2,148 |
1,422 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,979 |
7,018 |
$31K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
999 |
638 |
$27K |
| E1392 |
Portable oxygen concentrator, rental |
1,906 |
1,553 |
$16K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,046 |
649 |
$16K |
| E0570 |
Nebulizer, with compressor |
2,593 |
2,002 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,436 |
958 |
$11K |
| E0776 |
Iv pole |
286 |
210 |
$10K |
| 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 |
306 |
211 |
$10K |
| 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 |
100 |
63 |
$8K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
572 |
424 |
$5K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
16 |
12 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
246 |
158 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
93 |
68 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
258 |
160 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
226 |
151 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,952 |
1,385 |
$892.31 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
190 |
123 |
$859.19 |
| A7037 |
Tubing used with positive airway pressure device |
508 |
342 |
$588.19 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,320 |
1,026 |
$565.04 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
24 |
12 |
$329.00 |
| A7035 |
Headgear used with positive airway pressure device |
278 |
189 |
$216.94 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
30 |
24 |
$204.01 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
17 |
12 |
$189.96 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
36 |
29 |
$112.00 |
| A7000 |
Canister, disposable, used with suction pump, each |
19 |
12 |
$55.20 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
43 |
27 |
$22.93 |
| A7002 |
Tubing, used with suction pump, each |
22 |
13 |
$3.80 |