| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
17,681 |
12,335 |
$5.12M |
| 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 |
5,323 |
4,820 |
$2.93M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
7,078 |
6,031 |
$2.70M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,853 |
1,751 |
$1.23M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
8,016 |
5,950 |
$1.23M |
| 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 |
7,245 |
6,627 |
$1.08M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,671 |
9,665 |
$852K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,776 |
5,408 |
$767K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,599 |
3,455 |
$722K |
| 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 |
2,184 |
1,947 |
$607K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
6,892 |
3,470 |
$556K |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
2,782 |
1,669 |
$532K |
| 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 |
1,114 |
1,006 |
$513K |
| A7526 |
Tracheostomy tube collar/holder, each |
13,888 |
8,073 |
$298K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,842 |
3,046 |
$293K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
1,112 |
431 |
$288K |
| 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 |
2,311 |
1,924 |
$277K |
| 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 |
2,148 |
1,865 |
$272K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,163 |
1,151 |
$258K |
| A4605 |
Tracheal suction catheter, closed system, each |
3,564 |
3,236 |
$237K |
| A4927 |
Gloves, non-sterile, per 100 |
7,465 |
5,967 |
$211K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,880 |
1,649 |
$188K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,374 |
2,373 |
$167K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,598 |
2,473 |
$155K |
| A4217 |
Sterile water/saline, 500 ml |
5,706 |
5,369 |
$126K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,865 |
6,864 |
$123K |
| 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 |
2,177 |
1,830 |
$105K |
| S9502 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
312 |
122 |
$101K |
| 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 |
395 |
343 |
$98K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
4,804 |
4,759 |
$95K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
913 |
871 |
$94K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
438 |
113 |
$92K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
9,084 |
7,171 |
$91K |
| 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 |
2,958 |
2,956 |
$76K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
530 |
516 |
$58K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,382 |
5,062 |
$58K |
| E0570 |
Nebulizer, with compressor |
1,598 |
1,593 |
$50K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,058 |
1,058 |
$49K |
| A7000 |
Canister, disposable, used with suction pump, each |
11,491 |
10,451 |
$48K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
5,441 |
5,199 |
$46K |
| A4623 |
Tracheostomy, inner cannula |
726 |
694 |
$41K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,534 |
1,532 |
$39K |
| 99601 |
|
489 |
213 |
$35K |
| S9338 |
Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
421 |
280 |
$33K |
| B4100 |
Food thickener, administered orally, per ounce |
347 |
333 |
$31K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
259 |
259 |
$30K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,521 |
640 |
$29K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,859 |
4,702 |
$28K |
| L8501 |
Tracheostomy speaking valve |
555 |
534 |
$28K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
560 |
559 |
$22K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
6,512 |
6,142 |
$20K |
| A7002 |
Tubing, used with suction pump, each |
9,829 |
9,018 |
$19K |
| A7012 |
Water collection device, used with large volume nebulizer |
3,375 |
3,249 |
$15K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
778 |
775 |
$15K |
| S9501 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
33 |
12 |
$11K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
624 |
599 |
$9K |
| S9341 |
Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
28 |
24 |
$8K |
| A7525 |
Tracheostomy mask, each |
5,548 |
4,376 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
114 |
113 |
$7K |
| S9374 |
Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
44 |
14 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
313 |
312 |
$6K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
332 |
331 |
$6K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
156 |
156 |
$6K |
| S5502 |
Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) |
85 |
52 |
$5K |
| K0001 |
Standard wheelchair |
257 |
257 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
950 |
942 |
$4K |
| S5501 |
Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
23 |
12 |
$4K |
| A4332 |
Lubricant, individual sterile packet, each |
343 |
339 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
88 |
87 |
$3K |
| 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 |
15 |
14 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,170 |
2,143 |
$3K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,220 |
1,169 |
$2K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
74 |
24 |
$2K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
26 |
26 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
184 |
180 |
$2K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
231 |
208 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
12 |
12 |
$751.32 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
91 |
91 |
$683.92 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
340 |
325 |
$83.00 |
| A4481 |
Tracheostoma filter, any type, any size, each |
57 |
56 |
$64.78 |
| A4244 |
Alcohol or peroxide, per pint |
12 |
12 |
$30.48 |
| A4649 |
Surgical supply; miscellaneous |
112 |
109 |
$0.00 |