| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
27,741 |
7,165 |
$20.65M |
| 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 |
29,689 |
14,722 |
$9.13M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
106,901 |
33,873 |
$7.45M |
| 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 |
41,749 |
21,297 |
$3.86M |
| 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 |
19,463 |
8,930 |
$3.10M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
619 |
454 |
$1.50M |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
43,358 |
11,230 |
$1.04M |
| 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 |
19,297 |
6,846 |
$798K |
| 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 |
5,779 |
1,943 |
$738K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
67,232 |
3,429 |
$725K |
| B9002 |
Enteral nutrition infusion pump, any type |
8,897 |
8,181 |
$513K |
| 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 |
12,685 |
4,724 |
$494K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
7,514 |
667 |
$314K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
2,305 |
1,259 |
$314K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
11,403 |
10,208 |
$311K |
| 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 |
12,566 |
6,838 |
$272K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,947 |
1,652 |
$257K |
| J0585 |
Injection, onabotulinumtoxina, 1 unit |
175 |
117 |
$163K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
3,177 |
2,165 |
$140K |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
27,019 |
1,541 |
$114K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
430 |
319 |
$94K |
| S9502 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
1,791 |
177 |
$91K |
| S9501 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
2,000 |
120 |
$75K |
| S9379 |
Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
2,057 |
106 |
$71K |
| E0570 |
Nebulizer, with compressor |
1,033 |
947 |
$62K |
| E0776 |
Iv pole |
5,842 |
5,413 |
$52K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,392 |
1,244 |
$39K |
| S5501 |
Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
5,105 |
351 |
$34K |
| E0601 |
Continuous positive airway pressure (cpap) device |
840 |
767 |
$29K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
227 |
50 |
$24K |
| B4081 |
Nasogastric tubing with stylet |
1,382 |
1,063 |
$20K |
| S5502 |
Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) |
2,098 |
683 |
$16K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
239 |
214 |
$15K |
| B4100 |
Food thickener, administered orally, per ounce |
762 |
673 |
$14K |
| A7030 |
Full face mask used with positive airway pressure device, each |
292 |
254 |
$13K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
318 |
271 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
900 |
826 |
$9K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
98 |
40 |
$9K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
637 |
587 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
256 |
218 |
$5K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
252 |
235 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
316 |
271 |
$3K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
283 |
98 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
355 |
305 |
$3K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
49 |
37 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
59 |
59 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
152 |
133 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
859 |
747 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
86 |
66 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
155 |
140 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
269 |
227 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
134 |
105 |
$1K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
31 |
29 |
$973.00 |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
394 |
25 |
$941.80 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
51 |
39 |
$913.96 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
45 |
39 |
$892.18 |
| A7002 |
Tubing, used with suction pump, each |
142 |
110 |
$844.48 |
| A7015 |
Aerosol mask, used with dme nebulizer |
627 |
580 |
$604.92 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
214 |
163 |
$362.93 |
| K0001 |
Standard wheelchair |
16 |
12 |
$148.26 |
| B4104 |
Additive for enteral formula (e.g., fiber) |
168 |
96 |
$94.80 |