| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment, miscellaneous |
6,278 |
3,505 |
$3.15M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,165 |
2,722 |
$2.46M |
| A4927 |
Gloves, non-sterile, per 100 |
115,902 |
111,859 |
$2.29M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14,466 |
14,163 |
$1.84M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
45,184 |
44,333 |
$1.79M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
11,094 |
10,796 |
$1.56M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
11,631 |
11,423 |
$1.41M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12,523 |
12,197 |
$1.40M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
8,038 |
5,820 |
$1.17M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,919 |
3,805 |
$1.14M |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
388 |
360 |
$1.13M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
10,324 |
8,254 |
$1.08M |
| T4541 |
Incontinence product, disposable underpad, large, each |
45,880 |
44,944 |
$985K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,260 |
6,115 |
$894K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
17,375 |
16,994 |
$805K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
3,813 |
3,707 |
$725K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,718 |
4,397 |
$659K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,671 |
1,566 |
$623K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,506 |
7,282 |
$606K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,859 |
10,004 |
$575K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
9,208 |
7,725 |
$550K |
| K0861 |
Power wheelchair, group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
295 |
265 |
$525K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
4,086 |
3,839 |
$496K |
| 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 |
14,414 |
9,821 |
$454K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
3,879 |
3,599 |
$441K |
| K0005 |
Ultralightweight wheelchair |
615 |
565 |
$374K |
| 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 |
14,246 |
8,286 |
$368K |
| B4100 |
Food thickener, administered orally, per ounce |
7,324 |
6,833 |
$342K |
| 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 |
1,484 |
1,255 |
$320K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
394 |
372 |
$302K |
| 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 |
6,007 |
2,633 |
$301K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
5,480 |
3,176 |
$280K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
564 |
524 |
$280K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
6,806 |
6,330 |
$247K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,805 |
1,044 |
$209K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
1,469 |
1,375 |
$189K |
| 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 |
3,884 |
2,532 |
$179K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
5,391 |
4,774 |
$168K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,009 |
2,868 |
$160K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
8,987 |
8,149 |
$150K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,362 |
2,731 |
$149K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
365 |
342 |
$140K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,032 |
1,018 |
$139K |
| K0040 |
Adjustable angle footplate, each |
2,479 |
1,978 |
$122K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,471 |
2,352 |
$120K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,044 |
1,999 |
$112K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
967 |
862 |
$95K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
384 |
356 |
$90K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,120 |
864 |
$89K |
| W0137 |
|
483 |
477 |
$88K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,054 |
996 |
$87K |
| A7526 |
Tracheostomy tube collar/holder, each |
7,073 |
4,693 |
$86K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
676 |
643 |
$84K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,731 |
2,157 |
$79K |
| E0570 |
Nebulizer, with compressor |
6,514 |
6,254 |
$77K |
| A7030 |
Full face mask used with positive airway pressure device, each |
878 |
834 |
$74K |
| K0004 |
High strength, lightweight wheelchair |
2,979 |
2,819 |
$73K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,613 |
1,342 |
$66K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,080 |
987 |
$66K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
410 |
372 |
$65K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
563 |
538 |
$62K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
71 |
69 |
$60K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,687 |
2,560 |
$58K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,534 |
1,485 |
$58K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,401 |
1,329 |
$56K |
| A4623 |
Tracheostomy, inner cannula |
3,074 |
2,768 |
$54K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
459 |
398 |
$52K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,673 |
2,441 |
$51K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
545 |
512 |
$50K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,124 |
3,028 |
$48K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
554 |
467 |
$45K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
303 |
293 |
$44K |
| A4335 |
Incontinence supply; miscellaneous |
3,360 |
3,197 |
$43K |
| 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 |
592 |
527 |
$42K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
422 |
383 |
$42K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,671 |
1,618 |
$40K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,492 |
2,389 |
$39K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
748 |
640 |
$39K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
641 |
618 |
$38K |
| K0001 |
Standard wheelchair |
2,926 |
2,815 |
$38K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,993 |
1,755 |
$38K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,741 |
1,641 |
$38K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,204 |
5,137 |
$36K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,073 |
1,036 |
$36K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
289 |
265 |
$34K |
| 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 |
7,577 |
4,960 |
$32K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
798 |
730 |
$29K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
72 |
62 |
$29K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
1,436 |
1,121 |
$29K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
1,094 |
866 |
$28K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,384 |
1,313 |
$28K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,585 |
1,459 |
$27K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
865 |
849 |
$26K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
603 |
479 |
$26K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
890 |
865 |
$25K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,803 |
1,432 |
$24K |
| E0627 |
Seat lift mechanism, electric, any type |
286 |
278 |
$24K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,184 |
4,915 |
$22K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
61 |
59 |
$22K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
29 |
26 |
$21K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,639 |
1,519 |
$21K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,932 |
3,717 |
$20K |
| E0950 |
Wheelchair accessory, tray, each |
420 |
384 |
$20K |
| K0003 |
Lightweight wheelchair |
555 |
526 |
$19K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,490 |
1,390 |
$18K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,099 |
3,946 |
$18K |
| A7031 |
Face mask interface, replacement for full face mask, each |
600 |
543 |
$17K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
389 |
347 |
$17K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
2,063 |
1,753 |
$17K |
| B9998 |
Noc for enteral supplies |
190 |
166 |
$16K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
55 |
50 |
$16K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
466 |
423 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
5,902 |
4,339 |
$15K |
| E0194 |
Air fluidized bed |
14 |
12 |
$15K |
| E2389 |
Power wheelchair accessory, foam caster tire, any size, replacement only, each |
642 |
543 |
$15K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,921 |
3,687 |
$15K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
515 |
479 |
$14K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
345 |
300 |
$14K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,391 |
1,331 |
$14K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,659 |
1,477 |
$14K |
| E2300 |
Wheelchair accessory, power seat elevation system, any type |
15 |
12 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
313 |
301 |
$13K |
| A4332 |
Lubricant, individual sterile packet, each |
1,538 |
1,496 |
$13K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
155 |
137 |
$13K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
712 |
666 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
815 |
770 |
$13K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
1,476 |
1,453 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
692 |
606 |
$12K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,393 |
1,270 |
$12K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,465 |
2,345 |
$11K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
236 |
204 |
$11K |
| E2613 |
Positioning wheelchair back cushion, posterior, width less than 22 inches, any height, including any type mounting hardware |
70 |
67 |
$11K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
379 |
310 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,564 |
2,402 |
$10K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
1,832 |
1,706 |
$10K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,191 |
1,065 |
$9K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,298 |
1,208 |
$9K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,290 |
4,046 |
$9K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
514 |
425 |
$9K |
| K0019 |
Arm pad, replacement only, each |
927 |
750 |
$9K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
424 |
364 |
$9K |
| A4618 |
Breathing circuits |
661 |
499 |
$8K |
| K0007 |
Extra heavy duty wheelchair |
478 |
458 |
$8K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
17 |
12 |
$8K |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
739 |
559 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,220 |
2,038 |
$8K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,353 |
883 |
$8K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
294 |
277 |
$7K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
206 |
199 |
$7K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,098 |
1,000 |
$7K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
68 |
66 |
$7K |
| E0776 |
Iv pole |
1,396 |
1,350 |
$6K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
206 |
199 |
$6K |
| A4553 |
Non-disposable underpads, all sizes |
247 |
236 |
$6K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
272 |
250 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,236 |
1,562 |
$6K |
| E0325 |
Urinal; male, jug-type, any material |
1,337 |
1,246 |
$5K |
| A4554 |
Disposable underpads, all sizes |
599 |
570 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,778 |
1,697 |
$5K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
26 |
26 |
$4K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
584 |
559 |
$4K |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
469 |
431 |
$4K |
| A7525 |
Tracheostomy mask, each |
4,634 |
2,583 |
$4K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
81 |
56 |
$4K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
37 |
29 |
$4K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,242 |
1,143 |
$3K |
| A4402 |
Lubricant, per ounce |
1,006 |
941 |
$3K |
| 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 |
192 |
166 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
604 |
562 |
$3K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
104 |
98 |
$3K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
12 |
12 |
$2K |
| A4649 |
Surgical supply; miscellaneous |
92 |
81 |
$2K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
56 |
52 |
$2K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
159 |
145 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
426 |
399 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,339 |
1,293 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,162 |
1,039 |
$2K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
384 |
303 |
$2K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
29 |
25 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
122 |
120 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
294 |
288 |
$2K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
56 |
56 |
$2K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
76 |
70 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
24 |
24 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
219 |
207 |
$1K |
| E0156 |
Seat attachment, walker |
189 |
182 |
$1K |
| K0733 |
Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
54 |
54 |
$1K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
304 |
286 |
$1K |
| A4500 |
Surgical stockings below knee length, each |
41 |
41 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,916 |
1,779 |
$1K |
| A4322 |
Irrigation syringe, bulb or piston, each |
85 |
80 |
$1K |
| E0277 |
Powered pressure-reducing air mattress |
108 |
106 |
$1K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
115 |
114 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
38 |
38 |
$1K |
| A4367 |
Ostomy belt, each |
378 |
354 |
$785.27 |
| A7012 |
Water collection device, used with large volume nebulizer |
942 |
707 |
$755.33 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
29 |
28 |
$729.85 |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
15 |
14 |
$636.93 |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
18 |
13 |
$586.68 |
| S8999 |
Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
17 |
16 |
$578.00 |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
13 |
13 |
$562.00 |
| E0954 |
Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot |
39 |
34 |
$551.09 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
41 |
41 |
$468.84 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
118 |
112 |
$422.38 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
38 |
38 |
$389.19 |
| K0077 |
Front caster assembly, complete, with solid tire, replacement only, each |
19 |
12 |
$321.97 |
| E2374 |
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
12 |
12 |
$304.12 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
41 |
40 |
$279.68 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
642 |
629 |
$197.52 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
50 |
49 |
$178.23 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
12 |
12 |
$174.74 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
31 |
28 |
$117.11 |
| K0043 |
Footrest, lower extension tube, replacement only, each |
14 |
12 |
$115.64 |
| A4217 |
Sterile water/saline, 500 ml |
108 |
83 |
$110.15 |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
14 |
14 |
$108.60 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
13 |
13 |
$100.80 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
26 |
26 |
$85.12 |
| A4259 |
Lancets, per box of 100 |
73 |
67 |
$26.51 |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
63 |
63 |
$0.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
17 |
12 |
$0.00 |
| E0184 |
Dry pressure mattress |
508 |
477 |
$0.00 |
| 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 |
17 |
16 |
$0.00 |