| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
5,890 |
5,023 |
$831K |
| 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 |
2,112 |
1,653 |
$808K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,848 |
6,426 |
$752K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
25,225 |
19,925 |
$713K |
| 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 |
1,562 |
1,269 |
$413K |
| 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 |
3,942 |
3,147 |
$290K |
| 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 |
2,905 |
2,278 |
$180K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,834 |
2,844 |
$169K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,023 |
13,922 |
$122K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,824 |
1,601 |
$64K |
| 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 |
477 |
373 |
$60K |
| 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 |
277 |
208 |
$49K |
| B9998 |
Noc for enteral supplies |
2,928 |
2,007 |
$46K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
347 |
322 |
$44K |
| 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 |
1,612 |
1,299 |
$43K |
| E1392 |
Portable oxygen concentrator, rental |
2,792 |
2,206 |
$30K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,479 |
1,280 |
$29K |
| E0570 |
Nebulizer, with compressor |
4,344 |
3,395 |
$18K |
| E0776 |
Iv pole |
1,937 |
1,690 |
$13K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13 |
12 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,025 |
768 |
$575.35 |
| A7015 |
Aerosol mask, used with dme nebulizer |
18 |
16 |
$12.23 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
15 |
13 |
$6.30 |