| 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 |
12,518 |
4,715 |
$168K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
3,236 |
2,739 |
$135K |
| 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 |
8,801 |
3,566 |
$107K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,472 |
1,950 |
$76K |
| A4623 |
Tracheostomy, inner cannula |
4,792 |
4,097 |
$70K |
| 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 |
4,858 |
2,027 |
$64K |
| 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 |
3,779 |
1,330 |
$62K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,451 |
3,839 |
$44K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,076 |
1,315 |
$42K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,547 |
1,411 |
$29K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
2,566 |
2,080 |
$27K |
| 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 |
802 |
657 |
$26K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,846 |
1,574 |
$16K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,983 |
5,086 |
$8K |
| E0776 |
Iv pole |
4,775 |
4,268 |
$8K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,166 |
980 |
$7K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
4,798 |
4,061 |
$4K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
231 |
193 |
$4K |
| A4421 |
Ostomy supply; miscellaneous |
125 |
125 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
2,739 |
2,323 |
$3K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,108 |
1,593 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,023 |
1,579 |
$2K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
512 |
465 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
289 |
246 |
$2K |
| 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 |
200 |
179 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
224 |
194 |
$1K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
484 |
426 |
$669.64 |
| 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 |
29 |
26 |
$655.62 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
118 |
116 |
$432.60 |
| A5120 |
Skin barrier, wipes or swabs, each |
147 |
122 |
$367.86 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$312.72 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
277 |
235 |
$309.82 |
| A4217 |
Sterile water/saline, 500 ml |
20 |
17 |
$91.29 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
203 |
173 |
$44.38 |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
12 |
12 |
$14.16 |
| A4371 |
Ostomy skin barrier, powder, per oz |
231 |
198 |
$5.85 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
51 |
37 |
$0.00 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
32 |
25 |
$0.00 |