| 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 |
17,833 |
10,305 |
$688K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,625 |
2,589 |
$655K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,263 |
884 |
$527K |
| 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 |
848 |
716 |
$464K |
| 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 |
3,736 |
3,110 |
$457K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
4,662 |
2,416 |
$401K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
646 |
251 |
$200K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,173 |
698 |
$89K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,334 |
5,848 |
$72K |
| 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 |
471 |
387 |
$68K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,434 |
1,460 |
$56K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
470 |
330 |
$49K |
| A7030 |
Full face mask used with positive airway pressure device, each |
936 |
712 |
$41K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,498 |
1,124 |
$38K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
403 |
335 |
$35K |
| 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 |
267 |
212 |
$31K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
632 |
343 |
$24K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,947 |
1,779 |
$21K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
83 |
65 |
$20K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
891 |
617 |
$19K |
| A4217 |
Sterile water/saline, 500 ml |
432 |
329 |
$19K |
| A7526 |
Tracheostomy tube collar/holder, each |
847 |
598 |
$18K |
| A7037 |
Tubing used with positive airway pressure device |
1,721 |
1,257 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,273 |
3,292 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
1,402 |
1,023 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,146 |
817 |
$12K |
| E0570 |
Nebulizer, with compressor |
1,757 |
1,205 |
$10K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
102 |
69 |
$8K |
| E1392 |
Portable oxygen concentrator, rental |
1,055 |
639 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
1,549 |
1,061 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
154 |
98 |
$4K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
373 |
282 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
737 |
508 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
28 |
28 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,663 |
1,340 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
75 |
52 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
324 |
234 |
$739.27 |
| A7012 |
Water collection device, used with large volume nebulizer |
60 |
36 |
$174.57 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
43 |
24 |
$115.10 |
| A7525 |
Tracheostomy mask, each |
28 |
13 |
$14.07 |