| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,349 |
1,002 |
$18K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,172 |
1,613 |
$8K |
| 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 |
433 |
298 |
$6K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,214 |
2,243 |
$1K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
2,832 |
2,083 |
$513.01 |
| E0776 |
Iv pole |
1,106 |
805 |
$424.37 |
| B9002 |
Enteral nutrition infusion pump, any type |
299 |
222 |
$336.97 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
119 |
92 |
$244.98 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
29 |
25 |
$160.12 |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
53 |
42 |
$78.24 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
658 |
481 |
$31.63 |