| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
9,327 |
7,225 |
$5.80M |
| B9998 |
Noc for enteral supplies |
25,776 |
15,793 |
$4.32M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13,509 |
12,754 |
$3.66M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,620 |
2,563 |
$2.03M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,512 |
2,478 |
$1.94M |
| 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 |
6,372 |
6,006 |
$1.73M |
| 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 |
996 |
876 |
$1.46M |
| 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 |
3,336 |
2,934 |
$1.14M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,607 |
9,470 |
$1.10M |
| 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 |
3,082 |
2,831 |
$1.04M |
| E1399 |
Durable medical equipment, miscellaneous |
2,058 |
2,018 |
$1.00M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,884 |
2,854 |
$759K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
6,312 |
5,581 |
$650K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,114 |
3,019 |
$567K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,777 |
3,713 |
$443K |
| A4554 |
Disposable underpads, all sizes |
13,542 |
12,608 |
$415K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,397 |
3,180 |
$393K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,185 |
1,838 |
$377K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,001 |
1,817 |
$315K |
| 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 |
1,117 |
1,037 |
$301K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,866 |
2,716 |
$279K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
2,171 |
1,964 |
$265K |
| A7000 |
Canister, disposable, used with suction pump, each |
7,364 |
7,088 |
$246K |
| 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 |
715 |
673 |
$231K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,083 |
1,943 |
$222K |
| 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 |
317 |
288 |
$216K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,074 |
1,948 |
$198K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,931 |
8,792 |
$180K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,115 |
993 |
$173K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,243 |
1,181 |
$164K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,261 |
1,165 |
$162K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,801 |
1,721 |
$160K |
| A4322 |
Irrigation syringe, bulb or piston, each |
13,244 |
12,525 |
$159K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
249 |
189 |
$157K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
24,321 |
14,114 |
$155K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
2,991 |
1,880 |
$145K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,439 |
1,302 |
$142K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,010 |
1,824 |
$134K |
| E0570 |
Nebulizer, with compressor |
1,242 |
1,226 |
$130K |
| A7002 |
Tubing, used with suction pump, each |
7,211 |
6,946 |
$126K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
849 |
803 |
$125K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,804 |
3,428 |
$118K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,052 |
956 |
$115K |
| 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 |
560 |
480 |
$106K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
302 |
298 |
$105K |
| A4335 |
Incontinence supply; miscellaneous |
16,159 |
15,502 |
$86K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,629 |
2,418 |
$84K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
3,409 |
3,225 |
$81K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
672 |
629 |
$78K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
2,276 |
1,854 |
$74K |
| B4100 |
Food thickener, administered orally, per ounce |
3,197 |
3,077 |
$72K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,705 |
1,628 |
$51K |
| E0601 |
Continuous positive airway pressure (cpap) device |
477 |
473 |
$46K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
6,695 |
6,374 |
$40K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,958 |
7,523 |
$36K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
430 |
407 |
$35K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
597 |
560 |
$34K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
605 |
550 |
$33K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
317 |
297 |
$33K |
| E0776 |
Iv pole |
3,552 |
3,506 |
$33K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
3,514 |
3,331 |
$33K |
| A4402 |
Lubricant, per ounce |
5,989 |
5,656 |
$29K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
8,320 |
8,066 |
$28K |
| A7030 |
Full face mask used with positive airway pressure device, each |
293 |
284 |
$28K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,116 |
1,093 |
$24K |
| A4927 |
Gloves, non-sterile, per 100 |
2,841 |
2,715 |
$20K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
89 |
79 |
$19K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,576 |
2,445 |
$17K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,662 |
1,485 |
$16K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
7,438 |
7,227 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
544 |
529 |
$10K |
| A4217 |
Sterile water/saline, 500 ml |
495 |
477 |
$8K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
157 |
145 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
37 |
36 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
995 |
941 |
$4K |
| A7525 |
Tracheostomy mask, each |
1,090 |
1,030 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
28 |
27 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
398 |
356 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,095 |
2,929 |
$4K |
| A4670 |
Automatic blood pressure monitor |
72 |
72 |
$4K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
12 |
12 |
$3K |
| B4082 |
Nasogastric tubing without stylet |
55 |
51 |
$3K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
121 |
115 |
$3K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
81 |
81 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
498 |
454 |
$2K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
42 |
42 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
69 |
55 |
$767.20 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
13 |
12 |
$570.40 |
| A4245 |
Alcohol wipes, per box |
123 |
117 |
$521.60 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
27 |
25 |
$498.70 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
652 |
628 |
$418.13 |
| A4244 |
Alcohol or peroxide, per pint |
194 |
185 |
$142.65 |
| A4657 |
Syringe, with or without needle, each |
103 |
93 |
$109.44 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
13 |
12 |
$84.09 |