| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,702 |
2,406 |
$1.53M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,431 |
1,239 |
$855K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,135 |
9,755 |
$641K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,116 |
2,277 |
$449K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,502 |
5,178 |
$429K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,780 |
6,403 |
$367K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
6,395 |
3,238 |
$271K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,634 |
7,218 |
$266K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,665 |
1,066 |
$245K |
| A7031 |
Face mask interface, replacement for full face mask, each |
7,854 |
7,285 |
$243K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,290 |
1,075 |
$230K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,343 |
1,328 |
$230K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,403 |
2,622 |
$202K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
3,267 |
1,881 |
$180K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,032 |
6,712 |
$166K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,116 |
2,982 |
$159K |
| E1399 |
Durable medical equipment, miscellaneous |
2,905 |
2,753 |
$119K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,075 |
903 |
$116K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
3,548 |
3,373 |
$107K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,237 |
3,579 |
$102K |
| 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) |
629 |
594 |
$93K |
| A7035 |
Headgear used with positive airway pressure device |
5,207 |
4,970 |
$89K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,123 |
941 |
$72K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
17,567 |
16,457 |
$66K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,252 |
4,132 |
$63K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,470 |
2,327 |
$61K |
| B9998 |
Noc for enteral supplies |
534 |
485 |
$60K |
| E0570 |
Nebulizer, with compressor |
1,120 |
1,093 |
$49K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
4,105 |
3,862 |
$45K |
| A4217 |
Sterile water/saline, 500 ml |
1,547 |
1,121 |
$42K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,278 |
1,194 |
$36K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
793 |
585 |
$31K |
| A4623 |
Tracheostomy, inner cannula |
832 |
387 |
$30K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,893 |
2,366 |
$27K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,434 |
1,338 |
$23K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,086 |
1,594 |
$22K |
| K0001 |
Standard wheelchair |
862 |
812 |
$13K |
| A4927 |
Gloves, non-sterile, per 100 |
966 |
733 |
$12K |
| A7002 |
Tubing, used with suction pump, each |
2,927 |
2,281 |
$11K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,049 |
2,607 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
1,031 |
924 |
$9K |
| A7525 |
Tracheostomy mask, each |
1,512 |
1,265 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
786 |
765 |
$7K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
575 |
494 |
$5K |
| 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) |
13 |
13 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,860 |
1,674 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
218 |
199 |
$996.24 |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
96 |
76 |
$851.92 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
249 |
237 |
$655.93 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12 |
12 |
$294.00 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
12 |
12 |
$61.29 |
| B4224 |
Parenteral nutrition administration kit, per day |
15 |
12 |
$0.00 |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
15 |
12 |
$0.00 |