| 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 |
3,407 |
3,071 |
$103K |
| 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 |
1,301 |
1,037 |
$90K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
598 |
506 |
$47K |
| A7030 |
Full face mask used with positive airway pressure device, each |
239 |
224 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,405 |
1,314 |
$11K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
720 |
623 |
$10K |
| E0601 |
Continuous positive airway pressure (cpap) device |
362 |
309 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
389 |
369 |
$6K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
896 |
784 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
292 |
270 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
165 |
124 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
777 |
740 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
388 |
369 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
71 |
63 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
54 |
48 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
74 |
72 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
233 |
222 |
$1K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
54 |
51 |
$898.90 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
61 |
58 |
$358.57 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
15 |
15 |
$68.74 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
30 |
25 |
$51.38 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
53 |
53 |
$30.84 |