| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,262 |
3,253 |
$109K |
| 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 |
6,791 |
4,188 |
$69K |
| 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 |
1,474 |
871 |
$22K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,169 |
1,316 |
$16K |
| 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 |
907 |
505 |
$13K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
449 |
410 |
$1K |
| E0776 |
Iv pole |
515 |
471 |
$775.56 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
306 |
223 |
$537.44 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
176 |
153 |
$431.55 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
376 |
305 |
$305.67 |
| B9002 |
Enteral nutrition infusion pump, any type |
811 |
604 |
$148.42 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
389 |
312 |
$19.72 |