| 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 |
22,450 |
16,690 |
$296K |
| 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 |
2,500 |
1,972 |
$155K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
14,196 |
10,143 |
$108K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,775 |
1,115 |
$72K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,273 |
1,682 |
$72K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,680 |
1,058 |
$58K |
| 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 |
1,599 |
807 |
$53K |
| K0001 |
Standard wheelchair |
15,664 |
11,360 |
$45K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,409 |
3,409 |
$33K |
| E1392 |
Portable oxygen concentrator, rental |
19,611 |
14,613 |
$29K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,943 |
2,693 |
$22K |
| K0003 |
Lightweight wheelchair |
3,722 |
2,677 |
$17K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,014 |
828 |
$17K |
| B9002 |
Enteral nutrition infusion pump, any type |
614 |
493 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,198 |
1,863 |
$14K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,744 |
1,341 |
$13K |
| E0570 |
Nebulizer, with compressor |
7,431 |
5,579 |
$10K |
| 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 |
126 |
41 |
$9K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
164 |
140 |
$7K |
| 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 |
98 |
75 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,908 |
1,142 |
$7K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,242 |
1,254 |
$5K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,108 |
1,673 |
$3K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,284 |
1,000 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,135 |
918 |
$2K |
| A4623 |
Tracheostomy, inner cannula |
108 |
75 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,622 |
1,319 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,640 |
2,210 |
$1K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
768 |
515 |
$1K |
| E0156 |
Seat attachment, walker |
628 |
559 |
$865.90 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,322 |
1,044 |
$861.03 |
| E0776 |
Iv pole |
955 |
655 |
$831.27 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,135 |
995 |
$638.22 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
258 |
222 |
$595.03 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
616 |
303 |
$549.03 |
| A7030 |
Full face mask used with positive airway pressure device, each |
286 |
257 |
$483.29 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
548 |
496 |
$454.95 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
510 |
372 |
$415.10 |
| A7526 |
Tracheostomy tube collar/holder, each |
76 |
51 |
$379.39 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,414 |
1,230 |
$337.31 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
300 |
226 |
$269.24 |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
112 |
56 |
$266.01 |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
125 |
66 |
$245.66 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
13 |
12 |
$225.01 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
203 |
193 |
$162.42 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
48 |
40 |
$156.34 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
546 |
267 |
$138.26 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
392 |
244 |
$135.34 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
254 |
186 |
$127.49 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
554 |
372 |
$111.51 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
335 |
267 |
$100.70 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
310 |
226 |
$97.33 |
| A7035 |
Headgear used with positive airway pressure device |
651 |
576 |
$83.33 |
| 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) |
13 |
12 |
$81.93 |
| A7031 |
Face mask interface, replacement for full face mask, each |
218 |
192 |
$79.76 |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
28 |
14 |
$48.43 |
| A5120 |
Skin barrier, wipes or swabs, each |
246 |
177 |
$44.86 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
124 |
112 |
$38.56 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
271 |
250 |
$26.17 |
| A6260 |
Wound cleansers, any type, any size |
790 |
528 |
$16.12 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
82 |
53 |
$0.58 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
120 |
93 |
$0.44 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
27 |
24 |
$0.00 |
| 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 |
47 |
39 |
$0.00 |
| A7002 |
Tubing, used with suction pump, each |
31 |
15 |
$0.00 |