| 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 |
4,719 |
4,143 |
$3.54M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
16,943 |
11,171 |
$2.73M |
| 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 |
5,793 |
4,985 |
$2.14M |
| 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 |
3,939 |
3,480 |
$942K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,980 |
4,810 |
$811K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
27,834 |
3,655 |
$546K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,858 |
3,471 |
$428K |
| 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 |
473 |
446 |
$235K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
3,456 |
1,746 |
$229K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
8,505 |
4,713 |
$201K |
| 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 |
731 |
615 |
$184K |
| 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 |
653 |
568 |
$45K |
| B9002 |
Enteral nutrition infusion pump, any type |
254 |
253 |
$39K |
| B4224 |
Parenteral nutrition administration kit, per day |
324 |
74 |
$37K |
| E0776 |
Iv pole |
156 |
156 |
$25K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
86 |
41 |
$13K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
323 |
74 |
$12K |
| A4306 |
Disposable drug delivery system, flow rate of less than 50 ml per hour |
61 |
25 |
$6K |
| 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 |
13 |
12 |
$2K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
18 |
17 |
$92.70 |