| 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 |
3,915 |
3,373 |
$131K |
| E0570 |
Nebulizer, with compressor |
2,361 |
2,007 |
$105K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,910 |
3,447 |
$83K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,496 |
2,217 |
$73K |
| A7030 |
Full face mask used with positive airway pressure device, each |
955 |
877 |
$43K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,654 |
1,494 |
$41K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
455 |
401 |
$28K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,093 |
992 |
$26K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,198 |
1,030 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,227 |
1,043 |
$23K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,282 |
7,321 |
$21K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,626 |
2,302 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
1,803 |
1,651 |
$21K |
| K0001 |
Standard wheelchair |
1,252 |
1,046 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
1,384 |
1,223 |
$12K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
331 |
301 |
$11K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,098 |
1,002 |
$9K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,735 |
1,598 |
$7K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
575 |
486 |
$7K |
| 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 |
170 |
95 |
$5K |
| 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 |
189 |
107 |
$5K |
| 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 |
57 |
37 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
847 |
678 |
$2K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
14 |
12 |
$2K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
341 |
302 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,025 |
935 |
$1K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
873 |
479 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
518 |
472 |
$556.07 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
328 |
295 |
$255.70 |
| 99401 |
|
13 |
13 |
$115.40 |
| A4259 |
Lancets, per box of 100 |
57 |
50 |
$14.72 |
| 0003A |
|
24 |
24 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
130 |
75 |
$0.00 |
| 0004A |
|
95 |
94 |
$0.00 |
| 0002A |
|
61 |
60 |
$0.00 |
| 0124A |
|
83 |
81 |
$0.00 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
448 |
135 |
$0.00 |
| 90694 |
|
29 |
29 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
110 |
106 |
$0.00 |
| 0001A |
|
69 |
68 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
101 |
99 |
$0.00 |
| 86769 |
|
543 |
161 |
$0.00 |
| 90656 |
|
20 |
20 |
$0.00 |
| 0064A |
|
12 |
12 |
$0.00 |