| 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 |
8,521 |
8,051 |
$835K |
| 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 |
1,500 |
1,413 |
$801K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16,126 |
15,982 |
$599K |
| 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 |
1,933 |
1,768 |
$340K |
| 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 |
3,187 |
3,052 |
$278K |
| 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 |
4,426 |
4,222 |
$270K |
| 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 |
623 |
588 |
$217K |
| 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 |
362 |
339 |
$129K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,256 |
2,252 |
$120K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,837 |
1,740 |
$101K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,063 |
3,050 |
$79K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,639 |
1,626 |
$79K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,493 |
10,414 |
$77K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
781 |
761 |
$55K |
| E0570 |
Nebulizer, with compressor |
8,354 |
8,311 |
$52K |
| 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 |
713 |
687 |
$44K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,091 |
1,089 |
$39K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
788 |
787 |
$25K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,135 |
1,131 |
$23K |
| A7035 |
Headgear used with positive airway pressure device |
1,944 |
1,940 |
$22K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
811 |
809 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
2,462 |
2,457 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,932 |
4,901 |
$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 |
105 |
101 |
$16K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
409 |
408 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
901 |
895 |
$11K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,693 |
1,688 |
$11K |
| E0776 |
Iv pole |
3,356 |
3,353 |
$10K |
| E1392 |
Portable oxygen concentrator, rental |
615 |
614 |
$8K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
323 |
320 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
622 |
617 |
$4K |
| K0001 |
Standard wheelchair |
361 |
361 |
$4K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
163 |
159 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,824 |
1,741 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
176 |
173 |
$753.93 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
149 |
148 |
$488.57 |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
12 |
12 |
$432.61 |
| B9998 |
Noc for enteral supplies |
14 |
12 |
$282.24 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
84 |
83 |
$28.86 |
| A7015 |
Aerosol mask, used with dme nebulizer |
25 |
24 |
$16.47 |