| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
14,679 |
13,694 |
$9.68M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
22,782 |
21,806 |
$6.06M |
| 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 |
23,494 |
22,518 |
$5.36M |
| B9998 |
Noc for enteral supplies |
32,764 |
23,854 |
$2.19M |
| 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 |
6,739 |
6,460 |
$2.16M |
| 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 |
3,749 |
3,532 |
$1.49M |
| 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 |
746 |
717 |
$881K |
| 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 |
1,693 |
1,562 |
$865K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
8,454 |
7,767 |
$782K |
| 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 |
2,564 |
2,467 |
$709K |
| 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 |
2,755 |
2,664 |
$604K |
| A4554 |
Disposable underpads, all sizes |
20,341 |
19,865 |
$601K |
| 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 |
804 |
760 |
$574K |
| B9002 |
Enteral nutrition infusion pump, any type |
6,770 |
6,649 |
$512K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,558 |
5,971 |
$508K |
| 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 |
2,819 |
2,589 |
$496K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,549 |
2,466 |
$322K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,145 |
1,995 |
$263K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,446 |
1,120 |
$214K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,288 |
2,206 |
$199K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,001 |
1,960 |
$196K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,313 |
1,272 |
$162K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,441 |
1,368 |
$154K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,145 |
2,073 |
$153K |
| A4322 |
Irrigation syringe, bulb or piston, each |
19,563 |
18,557 |
$151K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
950 |
931 |
$134K |
| A4335 |
Incontinence supply; miscellaneous |
25,470 |
24,698 |
$122K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,266 |
2,103 |
$120K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,250 |
1,148 |
$112K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
677 |
655 |
$101K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
399 |
343 |
$82K |
| A4452 |
Tape, waterproof, per 18 square inches |
9,775 |
9,414 |
$82K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,265 |
2,840 |
$78K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15,236 |
14,769 |
$77K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
1,305 |
1,266 |
$74K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,044 |
892 |
$71K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
904 |
801 |
$66K |
| B4100 |
Food thickener, administered orally, per ounce |
1,476 |
1,434 |
$48K |
| B4082 |
Nasogastric tubing without stylet |
1,071 |
949 |
$46K |
| E0776 |
Iv pole |
5,244 |
5,192 |
$35K |
| A7002 |
Tubing, used with suction pump, each |
3,087 |
2,970 |
$35K |
| A4927 |
Gloves, non-sterile, per 100 |
4,226 |
3,942 |
$32K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
2,282 |
1,919 |
$31K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
359 |
318 |
$28K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
977 |
872 |
$27K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,195 |
1,158 |
$25K |
| A4402 |
Lubricant, per ounce |
3,190 |
3,100 |
$21K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,203 |
2,976 |
$19K |
| B4081 |
Nasogastric tubing with stylet |
356 |
313 |
$16K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,948 |
2,691 |
$13K |
| T4541 |
Incontinence product, disposable underpad, large, each |
343 |
302 |
$10K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
617 |
602 |
$8K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
222 |
198 |
$7K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
61 |
61 |
$7K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
489 |
430 |
$7K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
69 |
50 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
405 |
380 |
$5K |
| A4371 |
Ostomy skin barrier, powder, per oz |
732 |
726 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,356 |
1,316 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
549 |
543 |
$4K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,184 |
1,128 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,715 |
1,667 |
$2K |
| A4259 |
Lancets, per box of 100 |
429 |
427 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
14 |
14 |
$1K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
147 |
144 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
178 |
150 |
$1K |
| A4245 |
Alcohol wipes, per box |
657 |
651 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
81 |
79 |
$939.31 |
| A6260 |
Wound cleansers, any type, any size |
69 |
68 |
$611.94 |
| A4456 |
Adhesive remover, wipes, any type, each |
14 |
14 |
$144.95 |
| A4256 |
Normal, low and high calibrator solution / chips |
12 |
12 |
$8.12 |