| 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 |
9,754 |
9,107 |
$788K |
| S5170 |
Home delivered meals, including preparation; per meal |
7,137 |
6,503 |
$719K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,346 |
7,494 |
$576K |
| 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) |
2,439 |
2,172 |
$302K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,453 |
2,389 |
$234K |
| E0570 |
Nebulizer, with compressor |
5,182 |
4,848 |
$224K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,751 |
7,011 |
$190K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,118 |
1,037 |
$130K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,241 |
2,166 |
$99K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
916 |
833 |
$80K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,700 |
2,623 |
$79K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
630 |
594 |
$78K |
| A7035 |
Headgear used with positive airway pressure device |
3,736 |
3,623 |
$76K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,741 |
4,427 |
$65K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,888 |
1,784 |
$45K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
465 |
407 |
$42K |
| A4554 |
Disposable underpads, all sizes |
1,457 |
1,274 |
$39K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,079 |
986 |
$37K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,476 |
1,441 |
$33K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
340 |
324 |
$33K |
| K0001 |
Standard wheelchair |
1,657 |
1,492 |
$31K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,384 |
7,178 |
$25K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,162 |
2,099 |
$22K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,025 |
991 |
$17K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,065 |
1,015 |
$14K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
288 |
265 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
3,101 |
3,039 |
$11K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
26 |
26 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
352 |
341 |
$3K |
| 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 |
14 |
12 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
55 |
48 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,112 |
2,014 |
$2K |
| E0156 |
Seat attachment, walker |
219 |
205 |
$2K |
| 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 |
14 |
12 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
111 |
98 |
$732.98 |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
12 |
12 |
$726.00 |
| A4927 |
Gloves, non-sterile, per 100 |
57 |
52 |
$354.36 |
| A7015 |
Aerosol mask, used with dme nebulizer |
187 |
179 |
$300.83 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
20 |
14 |
$234.24 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$130.24 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
17 |
14 |
$115.02 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
44 |
42 |
$59.81 |