| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
54,462 |
31,877 |
$830K |
| 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 |
35,604 |
21,927 |
$609K |
| 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 |
16,257 |
8,911 |
$499K |
| B9002 |
Enteral nutrition infusion pump, any type |
25,130 |
20,214 |
$239K |
| 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 |
10,332 |
5,852 |
$181K |
| A4623 |
Tracheostomy, inner cannula |
13,787 |
11,062 |
$100K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
61,360 |
46,553 |
$79K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,343 |
4,904 |
$73K |
| 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 |
808 |
513 |
$57K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
8,761 |
6,753 |
$47K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
65,929 |
49,034 |
$43K |
| E0776 |
Iv pole |
30,277 |
24,619 |
$37K |
| A7526 |
Tracheostomy tube collar/holder, each |
11,681 |
9,172 |
$31K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
7,287 |
5,509 |
$28K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
5,437 |
4,245 |
$25K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
8,859 |
6,774 |
$18K |
| A4417 |
Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each |
1,059 |
945 |
$17K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,232 |
1,672 |
$14K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
3,691 |
2,632 |
$13K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
4,345 |
3,226 |
$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 |
1,350 |
1,230 |
$12K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
2,241 |
1,817 |
$12K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,090 |
892 |
$10K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,621 |
2,327 |
$9K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
888 |
719 |
$8K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
1,429 |
1,085 |
$7K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,855 |
1,547 |
$6K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
735 |
622 |
$5K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
664 |
498 |
$4K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
114 |
102 |
$4K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
5,116 |
4,115 |
$4K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
952 |
773 |
$3K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
8,345 |
6,408 |
$3K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
923 |
701 |
$3K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
4,905 |
3,872 |
$3K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
543 |
417 |
$2K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
238 |
211 |
$2K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
645 |
499 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,204 |
946 |
$2K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
62 |
52 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
693 |
584 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
529 |
475 |
$1K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
837 |
665 |
$953.03 |
| A4354 |
Insertion tray with drainage bag but without catheter |
1,035 |
845 |
$595.94 |
| A5120 |
Skin barrier, wipes or swabs, each |
1,258 |
1,019 |
$581.73 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
401 |
305 |
$426.23 |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
175 |
146 |
$195.02 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
52 |
50 |
$129.88 |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
46 |
36 |
$108.01 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
68 |
60 |
$94.31 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
67 |
61 |
$59.37 |
| A4456 |
Adhesive remover, wipes, any type, each |
179 |
149 |
$50.39 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
14 |
12 |
$44.07 |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
14 |
13 |
$27.10 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
93 |
60 |
$21.08 |