| 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 |
21,125 |
15,324 |
$8.41M |
| 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 |
34,294 |
28,479 |
$5.63M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
27,195 |
22,249 |
$3.13M |
| B9998 |
Noc for enteral supplies |
52,681 |
25,544 |
$2.61M |
| 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 |
6,678 |
5,396 |
$1.42M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,721 |
1,691 |
$1.18M |
| E0570 |
Nebulizer, with compressor |
12,360 |
11,252 |
$787K |
| S8189 |
Tracheostomy supply, not otherwise classified |
7,456 |
3,349 |
$781K |
| 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 |
4,910 |
4,027 |
$751K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16,284 |
13,094 |
$721K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
8,610 |
6,644 |
$638K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
6,222 |
4,981 |
$497K |
| B9002 |
Enteral nutrition infusion pump, any type |
12,137 |
9,623 |
$488K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,286 |
1,840 |
$487K |
| A4217 |
Sterile water/saline, 500 ml |
7,190 |
5,237 |
$425K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,557 |
2,782 |
$408K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
6,313 |
5,194 |
$385K |
| E1399 |
Durable medical equipment, miscellaneous |
29,869 |
10,657 |
$380K |
| A7526 |
Tracheostomy tube collar/holder, each |
5,106 |
3,958 |
$320K |
| 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 |
3,180 |
2,684 |
$306K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
2,442 |
1,838 |
$286K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,252 |
1,036 |
$283K |
| A4452 |
Tape, waterproof, per 18 square inches |
18,409 |
14,424 |
$275K |
| 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 |
2,608 |
2,179 |
$270K |
| E0619 |
Apnea monitor, with recording feature |
2,249 |
1,875 |
$269K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
2,389 |
1,922 |
$259K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,713 |
1,863 |
$241K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,348 |
1,933 |
$236K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,115 |
956 |
$227K |
| 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 |
680 |
585 |
$214K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
19,367 |
15,876 |
$202K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
15,808 |
13,122 |
$163K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,718 |
3,887 |
$158K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,223 |
1,120 |
$154K |
| 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 |
4,034 |
3,279 |
$133K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
4,147 |
3,221 |
$131K |
| A6260 |
Wound cleansers, any type, any size |
5,353 |
4,683 |
$125K |
| B4100 |
Food thickener, administered orally, per ounce |
2,299 |
1,911 |
$113K |
| A7000 |
Canister, disposable, used with suction pump, each |
8,323 |
6,722 |
$108K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
4,574 |
3,551 |
$108K |
| A4927 |
Gloves, non-sterile, per 100 |
8,800 |
6,883 |
$107K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
10,213 |
9,227 |
$105K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
1,145 |
513 |
$104K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
2,056 |
1,859 |
$103K |
| B4082 |
Nasogastric tubing without stylet |
2,769 |
2,204 |
$102K |
| 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 |
565 |
492 |
$97K |
| A4625 |
Tracheostomy care kit for new tracheostomy |
990 |
777 |
$97K |
| A7002 |
Tubing, used with suction pump, each |
8,515 |
6,426 |
$96K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,929 |
4,186 |
$92K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,291 |
1,831 |
$90K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
5,782 |
5,032 |
$86K |
| E0776 |
Iv pole |
11,325 |
9,518 |
$82K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
468 |
415 |
$75K |
| A4618 |
Breathing circuits |
3,656 |
2,429 |
$75K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
5,943 |
4,601 |
$70K |
| E1405 |
Oxygen and water vapor enriching system with heated delivery |
2,168 |
1,821 |
$69K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,050 |
2,395 |
$68K |
| A4210 |
Needle-free injection device, each |
18,221 |
14,425 |
$66K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
20,271 |
16,868 |
$64K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
941 |
730 |
$61K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,372 |
1,158 |
$54K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
5,212 |
4,460 |
$51K |
| A4402 |
Lubricant, per ounce |
8,059 |
6,699 |
$43K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,021 |
871 |
$42K |
| A4456 |
Adhesive remover, wipes, any type, each |
6,732 |
5,712 |
$40K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,533 |
1,310 |
$35K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
3,391 |
2,847 |
$25K |
| A4371 |
Ostomy skin barrier, powder, per oz |
4,008 |
3,484 |
$25K |
| E1392 |
Portable oxygen concentrator, rental |
993 |
786 |
$24K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,177 |
1,035 |
$23K |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
9,669 |
8,763 |
$22K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
221 |
209 |
$21K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
200 |
155 |
$20K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,025 |
1,736 |
$19K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
754 |
645 |
$17K |
| L8501 |
Tracheostomy speaking valve |
177 |
157 |
$16K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
585 |
437 |
$15K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
87 |
85 |
$15K |
| A4245 |
Alcohol wipes, per box |
3,845 |
3,155 |
$13K |
| E0585 |
Nebulizer, with compressor and heater |
903 |
754 |
$12K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,213 |
1,043 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
11,081 |
9,904 |
$10K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
429 |
343 |
$10K |
| A7525 |
Tracheostomy mask, each |
2,153 |
1,639 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
643 |
497 |
$8K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
3,105 |
2,341 |
$7K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
1,561 |
1,493 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
205 |
186 |
$6K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
43 |
36 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,238 |
2,625 |
$5K |
| A4649 |
Surgical supply; miscellaneous |
1,432 |
906 |
$4K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,274 |
1,049 |
$4K |
| E0974 |
Manual wheelchair accessory, anti-rollback device, each |
1,039 |
910 |
$3K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
947 |
717 |
$3K |
| 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) |
29 |
25 |
$3K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
65 |
47 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
296 |
268 |
$3K |
| A4244 |
Alcohol or peroxide, per pint |
2,024 |
1,610 |
$3K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
385 |
282 |
$3K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
222 |
158 |
$3K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
63 |
51 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
152 |
104 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
278 |
241 |
$2K |
| A4616 |
Tubing (oxygen), per foot |
1,738 |
1,182 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
119 |
101 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,306 |
1,133 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
975 |
799 |
$1K |
| A4615 |
Cannula, nasal |
1,756 |
1,267 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
506 |
412 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
460 |
399 |
$1K |
| A7008 |
Large volume nebulizer, disposable, prefilled, used with aerosol compressor |
60 |
45 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
58 |
53 |
$442.39 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
17 |
13 |
$208.41 |
| E1355 |
Stand/rack |
48 |
41 |
$86.18 |
| A9270 |
Non-covered item or service |
664 |
437 |
$43.70 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
31 |
29 |
$13.41 |