| 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 |
35,557 |
29,407 |
$8.16M |
| 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 |
13,480 |
10,666 |
$4.46M |
| 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 |
11,485 |
7,669 |
$3.44M |
| 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 |
25,943 |
19,784 |
$2.34M |
| B9002 |
Enteral nutrition infusion pump, any type |
17,941 |
15,081 |
$1.40M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
9,668 |
8,771 |
$1.05M |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,217 |
1,673 |
$880K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
4,274 |
3,957 |
$677K |
| 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 |
5,006 |
3,451 |
$491K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,634 |
2,242 |
$424K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
4,432 |
3,552 |
$339K |
| 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 |
2,834 |
2,188 |
$338K |
| B4100 |
Food thickener, administered orally, per ounce |
7,371 |
6,735 |
$338K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,606 |
5,085 |
$324K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,806 |
4,452 |
$294K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
960 |
924 |
$277K |
| 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 |
813 |
636 |
$265K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,968 |
1,691 |
$232K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
4,447 |
4,080 |
$211K |
| 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 |
2,316 |
1,551 |
$211K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
1,544 |
1,308 |
$188K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,733 |
1,280 |
$165K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
185 |
160 |
$147K |
| A6210 |
Foam 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 |
1,057 |
876 |
$130K |
| A4217 |
Sterile water/saline, 500 ml |
2,341 |
1,838 |
$114K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,392 |
2,228 |
$95K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
723 |
622 |
$83K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,174 |
803 |
$74K |
| K0001 |
Standard wheelchair |
3,680 |
3,369 |
$73K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,060 |
819 |
$69K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,123 |
4,870 |
$69K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
3,973 |
3,570 |
$66K |
| E0776 |
Iv pole |
751 |
722 |
$63K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
1,601 |
1,334 |
$63K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,753 |
3,582 |
$59K |
| B4189 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix |
96 |
27 |
$50K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
4,765 |
2,896 |
$46K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
955 |
847 |
$41K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
234 |
181 |
$38K |
| E1399 |
Durable medical equipment, miscellaneous |
2,420 |
1,407 |
$38K |
| E0619 |
Apnea monitor, with recording feature |
177 |
167 |
$34K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,655 |
2,993 |
$33K |
| 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 |
63 |
52 |
$31K |
| A4400 |
Ostomy irrigation set |
543 |
349 |
$30K |
| A7526 |
Tracheostomy tube collar/holder, each |
779 |
597 |
$24K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
258 |
211 |
$24K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
291 |
282 |
$22K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
663 |
620 |
$20K |
| B4224 |
Parenteral nutrition administration kit, per day |
188 |
49 |
$19K |
| A4554 |
Disposable underpads, all sizes |
76 |
66 |
$17K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
270 |
227 |
$16K |
| A4605 |
Tracheal suction catheter, closed system, each |
268 |
186 |
$16K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
588 |
431 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
2,734 |
2,332 |
$13K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
190 |
143 |
$12K |
| A7503 |
Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each |
75 |
69 |
$11K |
| B9998 |
Noc for enteral supplies |
826 |
520 |
$10K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
258 |
203 |
$9K |
| A4245 |
Alcohol wipes, per box |
84 |
70 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,232 |
1,096 |
$7K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
504 |
412 |
$7K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
75 |
56 |
$6K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
83 |
38 |
$6K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
186 |
49 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,189 |
1,018 |
$6K |
| A4402 |
Lubricant, per ounce |
2,187 |
1,887 |
$6K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
665 |
528 |
$6K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
83 |
64 |
$5K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
4,319 |
3,599 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
785 |
618 |
$4K |
| A4371 |
Ostomy skin barrier, powder, per oz |
683 |
576 |
$3K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
160 |
107 |
$3K |
| A4332 |
Lubricant, individual sterile packet, each |
1,155 |
943 |
$3K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
43 |
37 |
$3K |
| E0570 |
Nebulizer, with compressor |
101 |
100 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
164 |
158 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
229 |
176 |
$688.24 |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
41 |
27 |
$623.00 |
| A4458 |
Enema bag with tubing, reusable |
207 |
173 |
$575.43 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
12 |
12 |
$428.35 |
| A4456 |
Adhesive remover, wipes, any type, each |
125 |
80 |
$386.48 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
168 |
128 |
$311.90 |
| A4616 |
Tubing (oxygen), per foot |
254 |
213 |
$231.65 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
90 |
63 |
$161.70 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
51 |
29 |
$150.10 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,516 |
1,269 |
$139.21 |
| A4452 |
Tape, waterproof, per 18 square inches |
123 |
94 |
$40.20 |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
13 |
12 |
$1.73 |