| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
23,475 |
13,098 |
$1.10M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,774 |
870 |
$941K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,470 |
2,053 |
$367K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,156 |
1,123 |
$292K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,181 |
540 |
$243K |
| 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 |
824 |
691 |
$119K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,250 |
6,334 |
$99K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,753 |
2,210 |
$92K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
654 |
517 |
$69K |
| E1392 |
Portable oxygen concentrator, rental |
4,590 |
2,683 |
$59K |
| A7030 |
Full face mask used with positive airway pressure device, each |
680 |
489 |
$41K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,325 |
965 |
$40K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
709 |
441 |
$38K |
| E0570 |
Nebulizer, with compressor |
4,974 |
3,346 |
$36K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,438 |
2,613 |
$32K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
104 |
89 |
$26K |
| A7526 |
Tracheostomy tube collar/holder, each |
925 |
736 |
$25K |
| A4217 |
Sterile water/saline, 500 ml |
462 |
366 |
$22K |
| 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 |
48 |
39 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
1,690 |
1,217 |
$19K |
| A7000 |
Canister, disposable, used with suction pump, each |
848 |
698 |
$18K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,276 |
3,237 |
$16K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
480 |
330 |
$16K |
| A7035 |
Headgear used with positive airway pressure device |
1,170 |
862 |
$15K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
323 |
239 |
$11K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
53 |
51 |
$7K |
| K0001 |
Standard wheelchair |
622 |
314 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
722 |
604 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,803 |
1,406 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
303 |
240 |
$3K |
| L8501 |
Tracheostomy speaking valve |
20 |
12 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
151 |
113 |
$861.64 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
36 |
28 |
$682.42 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
27 |
24 |
$356.89 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
15 |
12 |
$290.11 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
16 |
13 |
$264.94 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
103 |
50 |
$242.07 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
27 |
25 |
$11.22 |