| 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 |
10,524 |
10,096 |
$793K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,588 |
4,477 |
$250K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,334 |
2,295 |
$243K |
| E0570 |
Nebulizer, with compressor |
5,918 |
5,691 |
$218K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,849 |
3,758 |
$186K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,064 |
6,826 |
$93K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,243 |
5,131 |
$83K |
| A7037 |
Tubing used with positive airway pressure device |
3,744 |
3,683 |
$78K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,436 |
1,325 |
$73K |
| A7035 |
Headgear used with positive airway pressure device |
2,614 |
2,575 |
$50K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
798 |
790 |
$50K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,783 |
6,650 |
$47K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
868 |
862 |
$42K |
| 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) |
401 |
393 |
$41K |
| K0001 |
Standard wheelchair |
1,798 |
1,679 |
$35K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
265 |
263 |
$29K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
471 |
455 |
$24K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,543 |
1,520 |
$17K |
| 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 |
1,038 |
1,005 |
$16K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
208 |
207 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
227 |
226 |
$11K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
554 |
540 |
$10K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
233 |
233 |
$7K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
43 |
43 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,765 |
1,725 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,057 |
966 |
$5K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
40 |
36 |
$4K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
243 |
225 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
28 |
24 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$1K |
| 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 |
32 |
13 |
$898.47 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
14 |
14 |
$660.16 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
55 |
25 |
$349.67 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
41 |
41 |
$192.69 |