| 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 |
8,933 |
7,112 |
$315K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,755 |
1,010 |
$159K |
| 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 |
415 |
286 |
$147K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,258 |
6,620 |
$109K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
445 |
243 |
$92K |
| K0001 |
Standard wheelchair |
8,004 |
6,791 |
$85K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
19 |
12 |
$77K |
| 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 |
522 |
384 |
$69K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
595 |
361 |
$62K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
632 |
562 |
$50K |
| B9998 |
Noc for enteral supplies |
871 |
519 |
$50K |
| 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 |
890 |
667 |
$43K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
263 |
245 |
$42K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
378 |
207 |
$40K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,189 |
4,387 |
$40K |
| B9002 |
Enteral nutrition infusion pump, any type |
648 |
504 |
$36K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
615 |
469 |
$32K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,655 |
1,294 |
$31K |
| E1009 |
Wheelchair accessory, addition to power seating system, mechanically linked leg elevation system, including pushrod and leg rest, each |
23 |
14 |
$29K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,556 |
1,245 |
$28K |
| S8120 |
Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
1,445 |
687 |
$27K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
23 |
14 |
$25K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
6,650 |
3,038 |
$24K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,347 |
1,217 |
$23K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
495 |
391 |
$21K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,199 |
1,074 |
$21K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
633 |
453 |
$21K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
922 |
804 |
$20K |
| K0006 |
Heavy duty wheelchair |
695 |
592 |
$20K |
| A7030 |
Full face mask used with positive airway pressure device, each |
360 |
317 |
$18K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
738 |
501 |
$17K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,263 |
933 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
506 |
486 |
$16K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
854 |
676 |
$15K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
271 |
208 |
$14K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
587 |
483 |
$14K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
89 |
77 |
$13K |
| K0007 |
Extra heavy duty wheelchair |
364 |
314 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
624 |
551 |
$13K |
| A7526 |
Tracheostomy tube collar/holder, each |
230 |
177 |
$12K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
504 |
456 |
$12K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
34 |
18 |
$10K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
46 |
42 |
$10K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
349 |
292 |
$9K |
| E0570 |
Nebulizer, with compressor |
1,702 |
1,581 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
222 |
202 |
$8K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
686 |
520 |
$8K |
| 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 |
53 |
39 |
$8K |
| E0251 |
Hospital bed, fixed height, with any type side rails, without mattress |
930 |
669 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
244 |
219 |
$7K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
404 |
315 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
669 |
621 |
$7K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
55 |
33 |
$7K |
| A7031 |
Face mask interface, replacement for full face mask, each |
297 |
255 |
$7K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
172 |
161 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
116 |
62 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,050 |
494 |
$5K |
| K0040 |
Adjustable angle footplate, each |
65 |
37 |
$5K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
32 |
28 |
$5K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
19 |
12 |
$4K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
550 |
476 |
$4K |
| K0003 |
Lightweight wheelchair |
242 |
202 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
27 |
14 |
$4K |
| 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 |
154 |
117 |
$3K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
74 |
53 |
$3K |
| E0184 |
Dry pressure mattress |
95 |
74 |
$3K |
| A4657 |
Syringe, with or without needle, each |
472 |
313 |
$3K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
57 |
52 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,057 |
896 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
232 |
194 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
240 |
182 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
214 |
161 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
231 |
146 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
237 |
158 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
19 |
14 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
108 |
85 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
168 |
159 |
$1K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
240 |
119 |
$992.70 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
72 |
63 |
$978.42 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
492 |
309 |
$941.18 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
125 |
78 |
$808.42 |
| E0277 |
Powered pressure-reducing air mattress |
16 |
12 |
$776.55 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
184 |
134 |
$657.56 |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
31 |
26 |
$535.08 |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
13 |
13 |
$523.73 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
66 |
61 |
$398.93 |
| E2202 |
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
26 |
24 |
$337.36 |
| E0266 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress |
14 |
12 |
$291.69 |
| A7525 |
Tracheostomy mask, each |
37 |
25 |
$171.65 |
| E1392 |
Portable oxygen concentrator, rental |
12 |
12 |
$153.91 |
| A7037 |
Tubing used with positive airway pressure device |
14 |
12 |
$149.88 |
| A4615 |
Cannula, nasal |
127 |
75 |
$115.03 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
25 |
25 |
$73.00 |