| 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 |
7,602 |
5,424 |
$3.75M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
41,441 |
38,695 |
$2.34M |
| E0601 |
Continuous positive airway pressure (cpap) device |
41,174 |
39,554 |
$2.26M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,262 |
12,923 |
$2.24M |
| 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 |
8,969 |
6,922 |
$1.57M |
| 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 |
12,250 |
8,741 |
$1.44M |
| B9998 |
Noc for enteral supplies |
18,946 |
12,525 |
$1.39M |
| 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 |
2,774 |
1,929 |
$1.26M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,849 |
2,060 |
$1.21M |
| E0570 |
Nebulizer, with compressor |
35,357 |
33,327 |
$1.01M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
17,692 |
16,651 |
$1.00M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
4,737 |
4,611 |
$820K |
| 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 |
2,766 |
1,955 |
$810K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
32,470 |
30,448 |
$680K |
| 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 |
6,480 |
4,855 |
$631K |
| A4670 |
Automatic blood pressure monitor |
16,677 |
16,151 |
$614K |
| 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) |
4,796 |
4,562 |
$603K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
11,338 |
10,598 |
$597K |
| A7030 |
Full face mask used with positive airway pressure device, each |
8,526 |
8,124 |
$519K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
3,969 |
3,793 |
$515K |
| K0001 |
Standard wheelchair |
14,266 |
13,447 |
$493K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13,845 |
13,133 |
$475K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,059 |
4,648 |
$471K |
| 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 |
2,052 |
1,589 |
$368K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,009 |
3,778 |
$357K |
| T4541 |
Incontinence product, disposable underpad, large, each |
9,983 |
9,366 |
$348K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,128 |
2,960 |
$342K |
| K0003 |
Lightweight wheelchair |
5,210 |
4,909 |
$333K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
9,319 |
7,459 |
$326K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,784 |
4,621 |
$302K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,321 |
3,071 |
$300K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,034 |
2,858 |
$290K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,261 |
1,166 |
$285K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,411 |
1,325 |
$284K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
7,543 |
7,141 |
$284K |
| A7035 |
Headgear used with positive airway pressure device |
13,863 |
13,067 |
$279K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
5,286 |
4,179 |
$258K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,387 |
2,118 |
$248K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,597 |
5,213 |
$243K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,950 |
1,806 |
$224K |
| A7037 |
Tubing used with positive airway pressure device |
13,570 |
12,942 |
$207K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,633 |
1,485 |
$188K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
8,967 |
8,645 |
$181K |
| E0245 |
Tub stool or bench |
5,440 |
5,159 |
$178K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,114 |
2,627 |
$175K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,565 |
1,375 |
$174K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,584 |
1,409 |
$151K |
| 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 |
2,873 |
2,019 |
$150K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
2,805 |
2,720 |
$146K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,455 |
1,372 |
$138K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,714 |
1,590 |
$138K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
2,360 |
1,862 |
$137K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,436 |
2,103 |
$130K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,367 |
1,181 |
$122K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,570 |
1,481 |
$118K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,637 |
1,466 |
$117K |
| B4100 |
Food thickener, administered orally, per ounce |
1,186 |
972 |
$117K |
| A4927 |
Gloves, non-sterile, per 100 |
8,971 |
8,208 |
$113K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,646 |
1,570 |
$98K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,873 |
2,713 |
$97K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,367 |
1,232 |
$97K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
4,155 |
3,854 |
$96K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
632 |
562 |
$94K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,054 |
1,015 |
$90K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
3,886 |
3,632 |
$85K |
| A4623 |
Tracheostomy, inner cannula |
1,288 |
1,098 |
$84K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,005 |
680 |
$83K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
2,254 |
2,068 |
$80K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
756 |
708 |
$80K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,570 |
1,234 |
$78K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,983 |
2,608 |
$77K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
353 |
338 |
$75K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,897 |
3,710 |
$73K |
| K0006 |
Heavy duty wheelchair |
771 |
734 |
$72K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,921 |
1,664 |
$72K |
| E0244 |
Raised toilet seat |
1,674 |
1,601 |
$70K |
| E0277 |
Powered pressure-reducing air mattress |
248 |
244 |
$68K |
| E1238 |
Wheelchair, pediatric size, folding, adjustable, without seating system |
454 |
434 |
$66K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,032 |
890 |
$66K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
1,533 |
1,457 |
$65K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
163 |
117 |
$63K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
711 |
639 |
$58K |
| E0156 |
Seat attachment, walker |
5,837 |
5,566 |
$52K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,541 |
3,328 |
$52K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
554 |
542 |
$51K |
| E0619 |
Apnea monitor, with recording feature |
197 |
193 |
$51K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
304 |
295 |
$47K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,956 |
2,718 |
$47K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,672 |
1,589 |
$45K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,678 |
5,279 |
$43K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,259 |
3,825 |
$43K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
434 |
416 |
$40K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,345 |
3,826 |
$35K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
915 |
869 |
$32K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
321 |
305 |
$32K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
172 |
164 |
$30K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
1,497 |
1,379 |
$30K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
16,191 |
14,734 |
$30K |
| E1392 |
Portable oxygen concentrator, rental |
2,473 |
2,365 |
$30K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,333 |
1,259 |
$29K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
3,834 |
3,648 |
$29K |
| A7002 |
Tubing, used with suction pump, each |
4,731 |
3,909 |
$24K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
580 |
459 |
$22K |
| A4565 |
Slings |
4,209 |
3,855 |
$21K |
| A7036 |
Chinstrap used with positive airway pressure device |
2,103 |
2,023 |
$20K |
| A4217 |
Sterile water/saline, 500 ml |
397 |
342 |
$19K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,988 |
2,559 |
$19K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
325 |
262 |
$19K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
8,698 |
7,430 |
$18K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,411 |
1,329 |
$18K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,697 |
2,485 |
$15K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
70 |
62 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,027 |
969 |
$14K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
279 |
263 |
$13K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
656 |
623 |
$13K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
808 |
786 |
$11K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
259 |
241 |
$10K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
122 |
112 |
$10K |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
231 |
199 |
$10K |
| L4397 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
131 |
116 |
$9K |
| A7015 |
Aerosol mask, used with dme nebulizer |
6,569 |
5,581 |
$8K |
| E0776 |
Iv pole |
855 |
790 |
$8K |
| B4082 |
Nasogastric tubing without stylet |
458 |
287 |
$8K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
154 |
147 |
$6K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,066 |
885 |
$5K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
308 |
293 |
$5K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
132 |
124 |
$4K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
49 |
39 |
$4K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
17 |
15 |
$4K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
200 |
184 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,250 |
2,106 |
$4K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
188 |
93 |
$3K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
24 |
24 |
$3K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
58 |
54 |
$3K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
66 |
42 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
101 |
92 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
12 |
12 |
$2K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
43 |
40 |
$2K |
| E0241 |
Bath tub wall rail, each |
74 |
72 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
258 |
235 |
$1K |
| S8424 |
Gradient pressure aid (sleeve), ready made |
30 |
26 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
271 |
236 |
$948.35 |
| A7525 |
Tracheostomy mask, each |
871 |
452 |
$893.98 |
| L3924 |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
18 |
12 |
$742.78 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
114 |
73 |
$712.36 |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
12 |
12 |
$691.52 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
52 |
50 |
$548.04 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
831 |
768 |
$544.70 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
15 |
15 |
$506.20 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
14 |
13 |
$428.87 |
| E0184 |
Dry pressure mattress |
17 |
17 |
$255.00 |
| A4570 |
Splint |
26 |
26 |
$247.00 |
| A4452 |
Tape, waterproof, per 18 square inches |
18 |
14 |
$204.09 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
100 |
76 |
$139.90 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
32 |
24 |
$129.45 |
| A4402 |
Lubricant, per ounce |
26 |
24 |
$68.58 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
31 |
25 |
$44.85 |
| A5120 |
Skin barrier, wipes or swabs, each |
14 |
12 |
$34.00 |
| A7012 |
Water collection device, used with large volume nebulizer |
12 |
12 |
$22.50 |