| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
296,047 |
280,762 |
$110.80M |
| E0784 |
External ambulatory infusion pump, insulin |
97,863 |
88,105 |
$39.56M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
187,117 |
180,783 |
$23.29M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
36,121 |
33,864 |
$22.71M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
221,294 |
188,972 |
$17.39M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
188,973 |
167,060 |
$10.26M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
208,146 |
201,313 |
$6.84M |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
16,838 |
15,867 |
$6.22M |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
10,116 |
9,502 |
$5.07M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
7,138 |
6,249 |
$3.59M |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
77,589 |
66,943 |
$2.28M |
| A4231 |
Infusion set for external insulin pump, needle type |
22,677 |
22,039 |
$2.13M |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
13,572 |
11,770 |
$1.29M |
| E1399 |
Durable medical equipment, miscellaneous |
2,180 |
2,035 |
$1.29M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
10,548 |
8,990 |
$1.18M |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
77,430 |
67,482 |
$950K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
11,939 |
9,816 |
$640K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
12,268 |
10,363 |
$576K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,744 |
1,279 |
$530K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
13,477 |
11,997 |
$415K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
4,277 |
4,197 |
$408K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
6,623 |
5,640 |
$406K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
8,257 |
7,253 |
$405K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,312 |
1,069 |
$375K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
4,293 |
3,723 |
$318K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,944 |
3,599 |
$241K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,367 |
1,117 |
$214K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,269 |
1,018 |
$204K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
5,091 |
4,491 |
$196K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
2,638 |
2,386 |
$190K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
504 |
357 |
$190K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
5,086 |
4,397 |
$171K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
5,679 |
5,128 |
$164K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
3,799 |
3,298 |
$149K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
992 |
600 |
$148K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,843 |
2,167 |
$117K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
1,924 |
1,698 |
$104K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,317 |
1,051 |
$101K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
8,992 |
7,808 |
$92K |
| A4452 |
Tape, waterproof, per 18 square inches |
4,585 |
3,842 |
$83K |
| A5120 |
Skin barrier, wipes or swabs, each |
11,621 |
10,430 |
$79K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
6,520 |
5,665 |
$77K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
2,454 |
1,993 |
$71K |
| A4456 |
Adhesive remover, wipes, any type, each |
8,137 |
7,385 |
$69K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
516 |
443 |
$65K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
802 |
766 |
$62K |
| A4259 |
Lancets, per box of 100 |
7,801 |
7,005 |
$60K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,333 |
1,188 |
$57K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
5,219 |
4,843 |
$54K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
12 |
12 |
$49K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
1,454 |
1,216 |
$45K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
5,680 |
4,970 |
$38K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
1,319 |
1,286 |
$36K |
| A4371 |
Ostomy skin barrier, powder, per oz |
6,305 |
5,709 |
$35K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
670 |
602 |
$35K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
621 |
483 |
$31K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,110 |
3,428 |
$28K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,722 |
1,469 |
$24K |
| A4332 |
Lubricant, individual sterile packet, each |
2,645 |
2,211 |
$24K |
| K0603 |
Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each |
7,534 |
6,681 |
$24K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
134 |
105 |
$23K |
| T4541 |
Incontinence product, disposable underpad, large, each |
751 |
251 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
2,453 |
1,984 |
$19K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
189 |
179 |
$18K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
462 |
421 |
$16K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
245 |
67 |
$15K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
246 |
75 |
$15K |
| A4367 |
Ostomy belt, each |
2,627 |
2,403 |
$14K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
152 |
135 |
$12K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
59 |
49 |
$12K |
| A4326 |
Male external catheter with integral collection chamber, any type, each |
145 |
138 |
$11K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,389 |
2,889 |
$11K |
| A4402 |
Lubricant, per ounce |
2,406 |
2,143 |
$11K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
51 |
42 |
$9K |
| A6260 |
Wound cleansers, any type, any size |
1,250 |
1,020 |
$8K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,597 |
1,401 |
$7K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
918 |
849 |
$5K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
87 |
73 |
$5K |
| A4258 |
Spring-powered device for lancet, each |
817 |
704 |
$5K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
80 |
13 |
$5K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
152 |
124 |
$5K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
82 |
78 |
$5K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
271 |
188 |
$5K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
225 |
193 |
$5K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
705 |
671 |
$5K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
14 |
12 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
829 |
698 |
$4K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
230 |
209 |
$4K |
| A4245 |
Alcohol wipes, per box |
1,630 |
1,589 |
$4K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
45 |
37 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
152 |
38 |
$3K |
| A4256 |
Normal, low and high calibrator solution / chips |
974 |
828 |
$3K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
44 |
39 |
$3K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
25 |
24 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
24 |
13 |
$2K |
| E0607 |
Home blood glucose monitor |
47 |
42 |
$1K |
| E2102 |
Adjunctive, non-implanted continuous glucose monitor or receiver |
311 |
273 |
$771.08 |
| A4602 |
Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each |
240 |
227 |
$763.27 |
| E0787 |
External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing |
29 |
27 |
$561.50 |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
14 |
13 |
$530.87 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
14 |
13 |
$378.47 |
| A4356 |
External urethral clamp or compression device (not to be used for catheter clamp), each |
47 |
46 |
$289.15 |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
13 |
12 |
$156.27 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
13 |
12 |
$86.38 |
| A4226 |
Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week |
22 |
17 |
$0.00 |