| 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 |
71,464 |
70,702 |
$4.03M |
| E0601 |
Continuous positive airway pressure (cpap) device |
63,123 |
62,674 |
$1.78M |
| 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 |
1,676 |
1,450 |
$1.40M |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
1,989 |
1,897 |
$1.25M |
| K0001 |
Standard wheelchair |
48,371 |
47,812 |
$1.09M |
| 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) |
10,281 |
10,215 |
$744K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
67,013 |
65,428 |
$693K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
74,861 |
74,349 |
$674K |
| 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 |
4,925 |
3,779 |
$589K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
2,958 |
2,936 |
$587K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
824 |
800 |
$572K |
| E0277 |
Powered pressure-reducing air mattress |
3,151 |
3,042 |
$532K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
4,437 |
4,385 |
$483K |
| E0570 |
Nebulizer, with compressor |
11,769 |
11,679 |
$480K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,292 |
1,113 |
$435K |
| T4541 |
Incontinence product, disposable underpad, large, each |
30,031 |
29,045 |
$435K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,034 |
1,783 |
$432K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12,970 |
12,873 |
$431K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
10,614 |
10,506 |
$403K |
| K0003 |
Lightweight wheelchair |
10,721 |
10,670 |
$342K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
4,303 |
3,922 |
$316K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
8,527 |
8,454 |
$314K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
330 |
325 |
$312K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,479 |
1,408 |
$309K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
461 |
440 |
$306K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
1,920 |
1,866 |
$294K |
| 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 |
1,965 |
1,647 |
$292K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,789 |
9,369 |
$283K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,739 |
3,568 |
$281K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
9,163 |
8,919 |
$277K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,228 |
2,007 |
$257K |
| E0784 |
External ambulatory infusion pump, insulin |
1,172 |
1,171 |
$249K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,825 |
2,616 |
$240K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,623 |
6,542 |
$239K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
510 |
509 |
$234K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,135 |
7,839 |
$232K |
| K0006 |
Heavy duty wheelchair |
4,362 |
4,316 |
$221K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,154 |
13,277 |
$218K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
1,995 |
1,962 |
$217K |
| A7035 |
Headgear used with positive airway pressure device |
15,227 |
15,022 |
$179K |
| 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 |
958 |
805 |
$177K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,310 |
7,127 |
$176K |
| B9998 |
Noc for enteral supplies |
2,940 |
2,496 |
$169K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,429 |
5,200 |
$166K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
4,352 |
4,320 |
$150K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
2,964 |
1,520 |
$142K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,917 |
4,707 |
$140K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,170 |
1,157 |
$127K |
| A7037 |
Tubing used with positive airway pressure device |
11,728 |
11,608 |
$126K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
4,929 |
4,920 |
$120K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,686 |
2,474 |
$114K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,372 |
1,357 |
$112K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
390 |
382 |
$105K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
905 |
875 |
$104K |
| E0305 |
Bed side rails, half length |
10,831 |
10,696 |
$103K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
181 |
180 |
$103K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,234 |
2,164 |
$99K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,113 |
2,946 |
$97K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
2,035 |
2,029 |
$94K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
4,388 |
4,184 |
$88K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,945 |
3,896 |
$87K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,957 |
2,928 |
$85K |
| A7000 |
Canister, disposable, used with suction pump, each |
6,060 |
4,330 |
$80K |
| A4670 |
Automatic blood pressure monitor |
3,619 |
3,588 |
$77K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
3,086 |
3,052 |
$76K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,227 |
3,165 |
$72K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,474 |
9,384 |
$70K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,140 |
1,140 |
$69K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
7,328 |
7,244 |
$69K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
2,021 |
1,983 |
$65K |
| E0271 |
Mattress, innerspring |
9,341 |
9,216 |
$64K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,183 |
5,680 |
$59K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,711 |
1,582 |
$57K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,264 |
2,140 |
$57K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
328 |
106 |
$54K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
613 |
588 |
$50K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
2,618 |
2,591 |
$43K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,498 |
2,450 |
$42K |
| E1392 |
Portable oxygen concentrator, rental |
4,304 |
4,263 |
$42K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,063 |
2,046 |
$40K |
| A4623 |
Tracheostomy, inner cannula |
678 |
629 |
$38K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,079 |
1,063 |
$38K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
937 |
865 |
$37K |
| A4217 |
Sterile water/saline, 500 ml |
6,235 |
5,854 |
$35K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
482 |
446 |
$35K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,620 |
1,564 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,898 |
1,866 |
$32K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,316 |
3,118 |
$31K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
361 |
343 |
$30K |
| A4649 |
Surgical supply; miscellaneous |
2,309 |
1,904 |
$30K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,016 |
2,879 |
$30K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,491 |
5,313 |
$30K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
328 |
324 |
$29K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
894 |
893 |
$29K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,568 |
5,324 |
$28K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
674 |
671 |
$28K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,391 |
2,298 |
$27K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,321 |
2,194 |
$27K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
1,534 |
1,526 |
$26K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,874 |
4,621 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
7,212 |
6,799 |
$24K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
905 |
833 |
$24K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
652 |
630 |
$24K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,527 |
1,437 |
$23K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
657 |
627 |
$23K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,254 |
1,053 |
$23K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,510 |
3,489 |
$22K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,524 |
1,333 |
$21K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,401 |
1,382 |
$21K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,145 |
2,066 |
$20K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,369 |
1,246 |
$20K |
| A4335 |
Incontinence supply; miscellaneous |
3,789 |
3,530 |
$19K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,700 |
1,627 |
$19K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
528 |
527 |
$18K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
221 |
209 |
$17K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,379 |
1,297 |
$14K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
988 |
942 |
$14K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
724 |
701 |
$14K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
322 |
309 |
$14K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
3,269 |
3,183 |
$13K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,954 |
1,947 |
$13K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
402 |
304 |
$13K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
190 |
190 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
2,728 |
1,980 |
$13K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,212 |
2,200 |
$12K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
896 |
889 |
$12K |
| E0310 |
Bed side rails, full length |
1,087 |
1,075 |
$11K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,197 |
1,190 |
$10K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
254 |
247 |
$10K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
750 |
708 |
$9K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
5,663 |
1,530 |
$8K |
| K0005 |
Ultralightweight wheelchair |
39 |
36 |
$8K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
116 |
110 |
$8K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,360 |
1,353 |
$8K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
293 |
288 |
$8K |
| 94760 |
|
78 |
78 |
$8K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
550 |
546 |
$8K |
| A4402 |
Lubricant, per ounce |
1,147 |
1,099 |
$7K |
| E0635 |
Patient lift, electric with seat or sling |
233 |
233 |
$7K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,293 |
1,283 |
$7K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,767 |
1,747 |
$7K |
| E0776 |
Iv pole |
663 |
654 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
158 |
155 |
$6K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,209 |
1,203 |
$6K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
13 |
13 |
$6K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,430 |
2,355 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
7,986 |
7,858 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,900 |
7,804 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,085 |
2,001 |
$5K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
237 |
236 |
$5K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
16 |
16 |
$4K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
77 |
75 |
$4K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
52 |
51 |
$4K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
252 |
245 |
$4K |
| A4367 |
Ostomy belt, each |
1,027 |
1,000 |
$4K |
| A6260 |
Wound cleansers, any type, any size |
827 |
807 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
150 |
148 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
258 |
243 |
$3K |
| E1399 |
Durable medical equipment, miscellaneous |
398 |
376 |
$3K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
263 |
258 |
$3K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
209 |
200 |
$3K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
24 |
24 |
$2K |
| E0156 |
Seat attachment, walker |
753 |
745 |
$2K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
52 |
50 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
57 |
55 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
358 |
357 |
$2K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
131 |
126 |
$2K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
117 |
117 |
$2K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
280 |
267 |
$1K |
| L3260 |
Surgical boot/shoe, each |
38 |
38 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
220 |
219 |
$1K |
| E0244 |
Raised toilet seat |
38 |
38 |
$1K |
| A4259 |
Lancets, per box of 100 |
169 |
168 |
$918.91 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
28 |
28 |
$878.59 |
| 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 |
255 |
252 |
$850.03 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
56 |
56 |
$834.96 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
100 |
100 |
$627.51 |
| A7525 |
Tracheostomy mask, each |
507 |
454 |
$594.36 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
96 |
95 |
$564.97 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
14 |
13 |
$253.96 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$239.30 |
| E0245 |
Tub stool or bench |
13 |
13 |
$233.11 |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
12 |
12 |
$217.92 |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
289 |
289 |
$159.65 |
| A4615 |
Cannula, nasal |
663 |
541 |
$159.44 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
13 |
12 |
$156.54 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
40 |
40 |
$102.77 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
24 |
24 |
$97.02 |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
12 |
12 |
$96.56 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
55 |
51 |
$68.86 |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
1,749 |
1,660 |
$54.72 |
| A4322 |
Irrigation syringe, bulb or piston, each |
13 |
13 |
$43.33 |
| A4245 |
Alcohol wipes, per box |
56 |
53 |
$35.33 |
| A4332 |
Lubricant, individual sterile packet, each |
13 |
13 |
$18.79 |
| A4616 |
Tubing (oxygen), per foot |
14 |
13 |
$0.83 |
| A4246 |
Betadine or phisohex solution, per pint |
42 |
40 |
$0.00 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$0.00 |