| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
8,889 |
8,732 |
$482K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
1,120 |
1,054 |
$385K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
810 |
641 |
$159K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,157 |
1,040 |
$133K |
| E0745 |
Neuromuscular stimulator, electronic shock unit |
378 |
365 |
$90K |
| E0731 |
Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) |
390 |
371 |
$58K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
6,220 |
6,142 |
$52K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
456 |
444 |
$50K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
489 |
257 |
$42K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
829 |
799 |
$41K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,027 |
999 |
$40K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,097 |
1,065 |
$34K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
527 |
354 |
$31K |
| A4618 |
Breathing circuits |
5,667 |
5,605 |
$26K |
| K0001 |
Standard wheelchair |
1,074 |
1,029 |
$26K |
| E0601 |
Continuous positive airway pressure (cpap) device |
693 |
690 |
$24K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
334 |
278 |
$24K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
445 |
435 |
$11K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
50 |
49 |
$10K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
104 |
70 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
770 |
731 |
$9K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
656 |
635 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
113 |
113 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
6,538 |
6,450 |
$6K |
| A4670 |
Automatic blood pressure monitor |
248 |
231 |
$6K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
54 |
49 |
$5K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
70 |
59 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
158 |
155 |
$5K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
430 |
410 |
$5K |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
420 |
390 |
$4K |
| L0464 |
Tlso, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment |
14 |
12 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,277 |
1,254 |
$3K |
| E0156 |
Seat attachment, walker |
444 |
437 |
$3K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
54 |
54 |
$3K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
65 |
64 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
236 |
231 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
359 |
181 |
$2K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
360 |
183 |
$2K |
| E0245 |
Tub stool or bench |
28 |
25 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
55 |
55 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
76 |
75 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
166 |
166 |
$1K |
| A4630 |
Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient |
383 |
370 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
12 |
$855.92 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
202 |
201 |
$779.94 |
| A4927 |
Gloves, non-sterile, per 100 |
54 |
48 |
$773.75 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
540 |
518 |
$536.59 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
12 |
12 |
$231.91 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
24 |
24 |
$158.89 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$103.60 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
12 |
12 |
$80.96 |