| 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 |
18,438 |
17,522 |
$1.25M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
833 |
641 |
$637K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
8,246 |
7,769 |
$340K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,376 |
3,283 |
$281K |
| K0001 |
Standard wheelchair |
10,819 |
10,206 |
$259K |
| A4217 |
Sterile water/saline, 500 ml |
3,390 |
2,135 |
$234K |
| E0570 |
Nebulizer, with compressor |
5,881 |
5,735 |
$225K |
| 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 |
10,186 |
9,699 |
$217K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
2,907 |
1,174 |
$182K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,744 |
4,576 |
$164K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,774 |
2,674 |
$152K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
933 |
825 |
$134K |
| E1392 |
Portable oxygen concentrator, rental |
4,622 |
4,369 |
$133K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
211 |
211 |
$108K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
11,974 |
6,235 |
$95K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,962 |
1,881 |
$93K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,063 |
928 |
$88K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,733 |
1,602 |
$84K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,974 |
3,179 |
$82K |
| A7035 |
Headgear used with positive airway pressure device |
4,056 |
3,917 |
$75K |
| A4605 |
Tracheal suction catheter, closed system, each |
303 |
265 |
$73K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
364 |
328 |
$54K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,975 |
3,615 |
$49K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,038 |
2,001 |
$43K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
1,235 |
1,126 |
$43K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,880 |
5,493 |
$41K |
| A7526 |
Tracheostomy tube collar/holder, each |
622 |
563 |
$38K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,655 |
1,299 |
$34K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
158 |
149 |
$31K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
707 |
659 |
$31K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,139 |
2,058 |
$28K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,848 |
2,809 |
$25K |
| A4618 |
Breathing circuits |
1,201 |
937 |
$24K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,267 |
1,236 |
$22K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
363 |
331 |
$21K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
745 |
669 |
$20K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
843 |
785 |
$16K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
497 |
434 |
$16K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
352 |
342 |
$13K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,415 |
1,358 |
$11K |
| K0002 |
Standard hemi (low seat) wheelchair |
292 |
285 |
$11K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,354 |
2,136 |
$10K |
| K0003 |
Lightweight wheelchair |
365 |
359 |
$9K |
| A7037 |
Tubing used with positive airway pressure device |
575 |
567 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
794 |
595 |
$7K |
| 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 |
295 |
252 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
371 |
341 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
451 |
255 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,392 |
1,299 |
$4K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
505 |
406 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
26 |
25 |
$2K |
| K0004 |
High strength, lightweight wheelchair |
116 |
115 |
$2K |
| E0277 |
Powered pressure-reducing air mattress |
52 |
49 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
141 |
127 |
$1K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
118 |
112 |
$1K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
24 |
24 |
$959.72 |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
145 |
126 |
$816.21 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
660 |
525 |
$755.99 |
| E1399 |
Durable medical equipment, miscellaneous |
70 |
48 |
$638.51 |
| E0245 |
Tub stool or bench |
13 |
12 |
$512.08 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
66 |
39 |
$508.31 |
| A7015 |
Aerosol mask, used with dme nebulizer |
307 |
300 |
$467.85 |
| E0776 |
Iv pole |
250 |
220 |
$444.37 |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
43 |
26 |
$371.12 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13 |
13 |
$358.65 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
584 |
577 |
$343.29 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
137 |
130 |
$236.61 |
| 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 |
13 |
$232.55 |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
13 |
12 |
$143.03 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$141.67 |
| A7000 |
Canister, disposable, used with suction pump, each |
13 |
12 |
$105.46 |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
201 |
105 |
$0.00 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
14 |
14 |
$0.00 |
| E0203 |
Therapeutic lightbox, minimum 10,000 lux, table top model |
126 |
117 |
$0.00 |