| 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 |
10,108 |
5,551 |
$304K |
| 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 |
6,157 |
3,309 |
$302K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12,467 |
6,914 |
$238K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,467 |
3,094 |
$89K |
| A4554 |
Disposable underpads, all sizes |
1,137 |
987 |
$44K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
9,533 |
5,903 |
$42K |
| 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 |
759 |
449 |
$36K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
2,555 |
1,500 |
$32K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,163 |
1,289 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
504 |
425 |
$27K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,578 |
1,648 |
$27K |
| K0003 |
Lightweight wheelchair |
5,687 |
3,334 |
$25K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,294 |
878 |
$22K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
343 |
237 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
10,077 |
6,232 |
$15K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,810 |
1,140 |
$14K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,069 |
627 |
$11K |
| K0001 |
Standard wheelchair |
2,243 |
1,555 |
$11K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
217 |
194 |
$8K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
629 |
353 |
$7K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
993 |
256 |
$6K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
72 |
64 |
$6K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
531 |
322 |
$5K |
| K0002 |
Standard hemi (low seat) wheelchair |
658 |
431 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
731 |
374 |
$2K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
68 |
49 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
357 |
160 |
$923.68 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
69 |
28 |
$560.04 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
12 |
$409.07 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
82 |
44 |
$396.15 |
| E0570 |
Nebulizer, with compressor |
109 |
49 |
$343.40 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
30 |
24 |
$314.67 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
24 |
12 |
$173.52 |
| E0607 |
Home blood glucose monitor |
23 |
12 |
$88.85 |
| A4259 |
Lancets, per box of 100 |
77 |
44 |
$88.53 |