| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0784 |
External ambulatory infusion pump, insulin |
2,307 |
2,289 |
$13.05M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
19,960 |
19,209 |
$6.09M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
29,840 |
28,694 |
$1.93M |
| Z5999 |
|
2,386 |
1,254 |
$1.66M |
| A4231 |
Infusion set for external insulin pump, needle type |
10,001 |
9,596 |
$1.65M |
| 99199 |
Unlisted special service, procedure or report |
2,118 |
1,500 |
$967K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,668 |
8,564 |
$315K |
| E1399 |
Durable medical equipment, miscellaneous |
729 |
637 |
$179K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,192 |
2,166 |
$125K |
| B9998 |
Noc for enteral supplies |
3,430 |
3,200 |
$123K |
| 99429 |
|
285 |
211 |
$119K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,154 |
4,134 |
$102K |
| T4541 |
Incontinence product, disposable underpad, large, each |
30,732 |
30,529 |
$99K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
30,064 |
29,903 |
$89K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,278 |
5,267 |
$72K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,235 |
1,199 |
$70K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,510 |
5,485 |
$65K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
172 |
152 |
$54K |
| K0001 |
Standard wheelchair |
18,604 |
18,422 |
$47K |
| 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) |
683 |
612 |
$46K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
30,092 |
29,936 |
$38K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,652 |
2,636 |
$32K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,067 |
3,854 |
$31K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,624 |
11,429 |
$30K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,071 |
1,067 |
$23K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,514 |
6,389 |
$20K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,260 |
3,246 |
$17K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
92 |
92 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
33,595 |
33,392 |
$16K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,300 |
7,269 |
$13K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,304 |
4,245 |
$12K |
| A4335 |
Incontinence supply; miscellaneous |
12,101 |
12,033 |
$12K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
11,229 |
11,164 |
$12K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,997 |
4,979 |
$11K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
168 |
133 |
$10K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,917 |
2,888 |
$9K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,202 |
1,166 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,573 |
6,529 |
$8K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
2,429 |
2,429 |
$8K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
228 |
214 |
$8K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
42 |
41 |
$8K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
34,082 |
33,877 |
$7K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
811 |
810 |
$7K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,439 |
1,419 |
$7K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,265 |
5,241 |
$7K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,065 |
975 |
$6K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
28 |
26 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
4,300 |
4,275 |
$6K |
| E1353 |
Regulator |
2,095 |
2,086 |
$6K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
150 |
107 |
$6K |
| E0245 |
Tub stool or bench |
1,921 |
1,919 |
$5K |
| E1355 |
Stand/rack |
2,073 |
2,070 |
$4K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
376 |
357 |
$4K |
| A4670 |
Automatic blood pressure monitor |
215 |
210 |
$4K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,332 |
1,318 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,129 |
1,121 |
$3K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
872 |
866 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
759 |
756 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
743 |
742 |
$3K |
| K0003 |
Lightweight wheelchair |
2,751 |
2,733 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
958 |
956 |
$3K |
| 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) |
2,909 |
2,900 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,338 |
1,331 |
$3K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
13 |
$3K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
587 |
586 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
571 |
561 |
$2K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
48 |
47 |
$2K |
| 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 |
13 |
12 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,543 |
3,541 |
$2K |
| E0570 |
Nebulizer, with compressor |
4,132 |
4,129 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,122 |
3,122 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
554 |
541 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,327 |
1,311 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
785 |
779 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,054 |
1,043 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,766 |
1,758 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,238 |
1,229 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
6,967 |
6,961 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
1,499 |
1,489 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
6,663 |
6,660 |
$1K |
| E0271 |
Mattress, innerspring |
2,483 |
2,483 |
$1K |
| E0305 |
Bed side rails, half length |
2,510 |
2,510 |
$1K |
| A6260 |
Wound cleansers, any type, any size |
81 |
77 |
$977.22 |
| A4663 |
Blood pressure cuff only |
149 |
141 |
$952.11 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
153 |
152 |
$921.00 |
| E0156 |
Seat attachment, walker |
2,263 |
2,261 |
$903.26 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
39 |
38 |
$869.52 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
755 |
748 |
$846.54 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
884 |
879 |
$842.72 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
450 |
450 |
$804.66 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,707 |
1,689 |
$735.61 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
25 |
25 |
$722.41 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
5,599 |
5,574 |
$665.60 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
79 |
79 |
$588.62 |
| A4402 |
Lubricant, per ounce |
1,386 |
1,375 |
$468.44 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,827 |
7,820 |
$300.61 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
206 |
205 |
$232.30 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
627 |
627 |
$210.99 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,026 |
2,016 |
$203.41 |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,778 |
3,757 |
$168.52 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
36 |
36 |
$160.00 |
| 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 |
909 |
845 |
$103.91 |
| E0277 |
Powered pressure-reducing air mattress |
63 |
63 |
$55.47 |
| 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 |
411 |
406 |
$49.34 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
68 |
68 |
$21.68 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,137 |
1,131 |
$13.95 |
| A4371 |
Ostomy skin barrier, powder, per oz |
490 |
484 |
$4.64 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
192 |
192 |
$0.00 |
| 95811 |
|
138 |
116 |
$0.00 |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
163 |
146 |
$0.00 |
| A7036 |
Chinstrap used with positive airway pressure device |
13 |
13 |
$0.00 |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$0.00 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
24 |
24 |
$0.00 |
| 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 |
1,751 |
1,728 |
$0.00 |
| 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 |
652 |
641 |
$0.00 |
| 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 |
3,539 |
3,353 |
$0.00 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
127 |
127 |
$0.00 |