| 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 |
34,313 |
21,036 |
$1.13M |
| 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 |
6,241 |
5,187 |
$618K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,215 |
2,794 |
$514K |
| 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 |
2,035 |
1,487 |
$220K |
| 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 |
377 |
337 |
$185K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
992 |
495 |
$181K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,622 |
1,479 |
$141K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
19,580 |
12,196 |
$112K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
768 |
417 |
$74K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,449 |
1,034 |
$54K |
| E1392 |
Portable oxygen concentrator, rental |
5,051 |
3,176 |
$42K |
| 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 |
310 |
266 |
$40K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,064 |
1,232 |
$39K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,584 |
1,147 |
$37K |
| E0570 |
Nebulizer, with compressor |
3,695 |
2,500 |
$31K |
| 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 |
269 |
186 |
$31K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
279 |
214 |
$20K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,121 |
1,406 |
$17K |
| A7037 |
Tubing used with positive airway pressure device |
2,101 |
1,506 |
$16K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,869 |
2,951 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
1,206 |
882 |
$11K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
49 |
25 |
$10K |
| B9002 |
Enteral nutrition infusion pump, any type |
84 |
63 |
$6K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
40 |
24 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
84 |
58 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,559 |
1,181 |
$1K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
15 |
12 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
21 |
12 |
$810.27 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
97 |
75 |
$542.52 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
192 |
146 |
$485.77 |
| K0001 |
Standard wheelchair |
97 |
54 |
$388.50 |
| E0776 |
Iv pole |
15 |
12 |
$88.05 |
| A7002 |
Tubing, used with suction pump, each |
15 |
12 |
$57.63 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
15 |
13 |
$6.17 |