| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,832 |
2,335 |
$3.57M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
20,680 |
10,026 |
$2.25M |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
7,330 |
2,321 |
$1.51M |
| 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 |
6,033 |
2,417 |
$1.24M |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
2,612 |
1,314 |
$1.04M |
| 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 |
7,404 |
3,912 |
$504K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
16,949 |
7,241 |
$334K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
2,751 |
591 |
$330K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
2,390 |
1,232 |
$315K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,542 |
3,216 |
$288K |
| 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 |
3,675 |
2,018 |
$243K |
| B4224 |
Parenteral nutrition administration kit, per day |
2,939 |
584 |
$206K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,835 |
1,746 |
$141K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,462 |
390 |
$122K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
283 |
200 |
$106K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,660 |
2,530 |
$78K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
2,941 |
585 |
$61K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
83 |
81 |
$13K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
270 |
145 |
$10K |
| E0776 |
Iv pole |
575 |
504 |
$2K |