| 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 |
4,239 |
4,177 |
$203K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,224 |
1,204 |
$99K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,272 |
2,231 |
$97K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,966 |
1,912 |
$93K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
715 |
709 |
$32K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
874 |
856 |
$30K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
604 |
588 |
$27K |
| E0570 |
Nebulizer, with compressor |
2,635 |
2,543 |
$25K |
| A7037 |
Tubing used with positive airway pressure device |
1,323 |
1,307 |
$22K |
| 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 |
1,558 |
1,528 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,821 |
3,726 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,067 |
1,052 |
$16K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
566 |
557 |
$14K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
138 |
134 |
$12K |
| K0001 |
Standard wheelchair |
567 |
543 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
854 |
846 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
56 |
54 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
620 |
606 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
852 |
839 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
55 |
54 |
$5K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
133 |
132 |
$4K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
55 |
55 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
79 |
77 |
$1K |
| 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 |
43 |
43 |
$1K |
| T4541 |
Incontinence product, disposable underpad, large, each |
38 |
37 |
$971.36 |
| 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 |
38 |
38 |
$896.39 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
63 |
60 |
$820.72 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15 |
15 |
$793.44 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
36 |
36 |
$462.72 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
106 |
98 |
$236.80 |
| A7015 |
Aerosol mask, used with dme nebulizer |
25 |
25 |
$20.72 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
45 |
43 |
$17.16 |
| A7002 |
Tubing, used with suction pump, each |
13 |
12 |
$0.00 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
15 |
13 |
$0.00 |