| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,696 |
2,258 |
$1.58M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,786 |
4,522 |
$878K |
| 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 |
1,923 |
1,203 |
$612K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,119 |
2,048 |
$581K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,527 |
2,649 |
$415K |
| A4554 |
Disposable underpads, all sizes |
6,831 |
5,883 |
$410K |
| 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 |
1,232 |
629 |
$341K |
| 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 |
428 |
217 |
$242K |
| 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 |
2,208 |
1,317 |
$231K |
| A4927 |
Gloves, non-sterile, per 100 |
7,482 |
6,202 |
$187K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,335 |
1,042 |
$159K |
| 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 |
1,000 |
550 |
$123K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
5,164 |
4,327 |
$119K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,938 |
2,396 |
$112K |
| 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 |
515 |
268 |
$105K |
| A4553 |
Non-disposable underpads, all sizes |
386 |
350 |
$86K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,085 |
690 |
$72K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
734 |
484 |
$69K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
709 |
519 |
$53K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
642 |
453 |
$51K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
687 |
516 |
$42K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
596 |
419 |
$35K |
| B9998 |
Noc for enteral supplies |
856 |
587 |
$35K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
382 |
287 |
$31K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,923 |
1,439 |
$29K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
108 |
91 |
$17K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
557 |
534 |
$16K |
| B9002 |
Enteral nutrition infusion pump, any type |
77 |
54 |
$7K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
133 |
103 |
$7K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
106 |
61 |
$6K |
| 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 |
21 |
12 |
$5K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
322 |
219 |
$4K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
595 |
405 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13 |
13 |
$2K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
205 |
86 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
68 |
43 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
52 |
26 |
$1K |
| A4245 |
Alcohol wipes, per box |
92 |
68 |
$631.00 |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
65 |
52 |
$425.29 |
| T5999 |
Supply, not otherwise specified |
133 |
112 |
$379.41 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
65 |
44 |
$86.88 |
| A4244 |
Alcohol or peroxide, per pint |
182 |
140 |
$75.27 |
| A4649 |
Surgical supply; miscellaneous |
47 |
41 |
$0.00 |