| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Continuous positive airway pressure (cpap) device |
2,830 |
2,691 |
$101K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,762 |
1,635 |
$92K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,185 |
1,152 |
$47K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
463 |
460 |
$44K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
433 |
422 |
$42K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,088 |
1,058 |
$40K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
366 |
350 |
$36K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,088 |
2,021 |
$34K |
| A7030 |
Full face mask used with positive airway pressure device, each |
437 |
415 |
$30K |
| E0570 |
Nebulizer, with compressor |
1,024 |
919 |
$30K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
288 |
287 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
870 |
789 |
$20K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
729 |
692 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
1,715 |
1,632 |
$18K |
| K0001 |
Standard wheelchair |
888 |
817 |
$12K |
| E1392 |
Portable oxygen concentrator, rental |
853 |
789 |
$10K |
| 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) |
110 |
105 |
$9K |
| A7035 |
Headgear used with positive airway pressure device |
616 |
586 |
$9K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
50 |
50 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
237 |
204 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
168 |
159 |
$6K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
582 |
554 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
984 |
906 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
298 |
292 |
$4K |
| A4553 |
Non-disposable underpads, all sizes |
90 |
89 |
$4K |
| 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 |
79 |
79 |
$4K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
142 |
135 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
637 |
581 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
37 |
37 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
110 |
107 |
$3K |
| A4554 |
Disposable underpads, all sizes |
310 |
301 |
$3K |
| 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 |
12 |
12 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
69 |
68 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
38 |
38 |
$745.55 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
148 |
140 |
$737.27 |
| K0003 |
Lightweight wheelchair |
59 |
51 |
$679.06 |
| A7037 |
Tubing used with positive airway pressure device |
43 |
41 |
$669.06 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
32 |
32 |
$270.24 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
37 |
35 |
$236.93 |
| A7015 |
Aerosol mask, used with dme nebulizer |
333 |
326 |
$193.57 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
12 |
12 |
$129.60 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
360 |
351 |
$129.10 |