| 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 |
4,129 |
4,049 |
$2.30M |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,150 |
1,035 |
$2.09M |
| 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 |
6,068 |
5,947 |
$1.86M |
| 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 |
1,489 |
1,121 |
$864K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
273 |
263 |
$421K |
| 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 |
3,940 |
3,867 |
$408K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,431 |
2,318 |
$355K |
| B9998 |
Noc for enteral supplies |
397 |
294 |
$258K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,813 |
2,751 |
$204K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,593 |
4,407 |
$194K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,892 |
1,868 |
$169K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,158 |
2,117 |
$150K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,644 |
3,576 |
$105K |
| E1399 |
Durable medical equipment, miscellaneous |
254 |
239 |
$85K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
439 |
433 |
$78K |
| A4670 |
Automatic blood pressure monitor |
1,704 |
1,668 |
$75K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,635 |
1,621 |
$66K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
335 |
327 |
$53K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
104 |
104 |
$50K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
465 |
297 |
$32K |
| A4927 |
Gloves, non-sterile, per 100 |
2,086 |
2,024 |
$31K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
372 |
365 |
$30K |
| E0245 |
Tub stool or bench |
809 |
777 |
$27K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
137 |
72 |
$15K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,414 |
2,343 |
$15K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
872 |
866 |
$15K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
205 |
201 |
$15K |
| S5165 |
Home modifications; per service |
34 |
33 |
$15K |
| 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 |
71 |
71 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
118 |
114 |
$12K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
528 |
496 |
$11K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
15 |
15 |
$11K |
| K0002 |
Standard hemi (low seat) wheelchair |
134 |
129 |
$11K |
| E0570 |
Nebulizer, with compressor |
227 |
210 |
$11K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
27 |
27 |
$10K |
| 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 |
15 |
12 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
12 |
12 |
$9K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
49 |
49 |
$7K |
| E0241 |
Bath tub wall rail, each |
188 |
178 |
$6K |
| E0244 |
Raised toilet seat |
119 |
108 |
$6K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
527 |
510 |
$6K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
77 |
77 |
$6K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
62 |
61 |
$5K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
139 |
131 |
$3K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
268 |
267 |
$3K |
| A4322 |
Irrigation syringe, bulb or piston, each |
263 |
260 |
$3K |
| A4930 |
Gloves, sterile, per pair |
126 |
124 |
$2K |
| E0246 |
Transfer tub rail attachment |
26 |
20 |
$2K |
| E0156 |
Seat attachment, walker |
440 |
400 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
410 |
406 |
$2K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
13 |
12 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
282 |
272 |
$2K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
25 |
25 |
$2K |
| A6260 |
Wound cleansers, any type, any size |
87 |
78 |
$2K |
| E0310 |
Bed side rails, full length |
44 |
41 |
$2K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
51 |
51 |
$1K |
| E0627 |
Seat lift mechanism, electric, any type |
19 |
19 |
$895.78 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
64 |
63 |
$780.73 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
32 |
31 |
$593.01 |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
23 |
12 |
$499.79 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
54 |
51 |
$479.16 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
12 |
12 |
$246.17 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
17 |
17 |
$191.78 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$144.69 |