| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
883 |
800 |
$1.10M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,858 |
1,510 |
$301K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,751 |
3,061 |
$282K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,882 |
2,645 |
$217K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,186 |
1,088 |
$215K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,516 |
2,250 |
$154K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
3,476 |
2,928 |
$149K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
3,978 |
3,362 |
$144K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,948 |
1,684 |
$132K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,260 |
2,854 |
$76K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
4,091 |
3,337 |
$75K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,478 |
1,316 |
$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 |
339 |
246 |
$45K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,062 |
1,877 |
$33K |
| K0001 |
Standard wheelchair |
1,212 |
1,116 |
$30K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
403 |
326 |
$30K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
872 |
783 |
$26K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,303 |
1,951 |
$26K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
259 |
209 |
$22K |
| E0776 |
Iv pole |
1,919 |
1,677 |
$21K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,257 |
3,604 |
$19K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
295 |
232 |
$17K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
265 |
218 |
$16K |
| A4367 |
Ostomy belt, each |
2,420 |
2,072 |
$13K |
| A7037 |
Tubing used with positive airway pressure device |
608 |
583 |
$11K |
| A7030 |
Full face mask used with positive airway pressure device, each |
110 |
110 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,761 |
1,672 |
$9K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
143 |
143 |
$9K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
179 |
160 |
$9K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
70 |
62 |
$8K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,146 |
3,482 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,853 |
1,517 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
348 |
334 |
$6K |
| A7000 |
Canister, disposable, used with suction pump, each |
792 |
683 |
$4K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
12 |
12 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
382 |
328 |
$3K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
53 |
49 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
169 |
155 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
836 |
719 |
$2K |
| 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) |
38 |
36 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
740 |
649 |
$1K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
48 |
37 |
$1K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
14 |
13 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
121 |
113 |
$739.06 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
106 |
99 |
$679.51 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
14 |
12 |
$618.70 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
15 |
14 |
$536.13 |
| E0441 |
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
14 |
12 |
$529.46 |
| A7526 |
Tracheostomy tube collar/holder, each |
12 |
12 |
$189.04 |