| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,353 |
2,977 |
$5.01M |
| 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 |
5,883 |
5,086 |
$4.42M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,416 |
13,399 |
$3.47M |
| 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 |
7,491 |
6,642 |
$2.69M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
11,550 |
10,330 |
$2.21M |
| 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 |
6,510 |
5,940 |
$2.21M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,530 |
2,414 |
$2.17M |
| B9998 |
Noc for enteral supplies |
15,456 |
13,866 |
$1.94M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,975 |
3,402 |
$1.49M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
13,982 |
8,990 |
$1.41M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,355 |
13,964 |
$1.10M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,830 |
6,503 |
$1.00M |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
12,012 |
11,770 |
$585K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,194 |
2,629 |
$551K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
6,631 |
5,568 |
$472K |
| A4927 |
Gloves, non-sterile, per 100 |
13,215 |
12,669 |
$395K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,092 |
2,944 |
$369K |
| 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 |
669 |
590 |
$365K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,809 |
10,598 |
$364K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,744 |
3,568 |
$347K |
| B9002 |
Enteral nutrition infusion pump, any type |
6,251 |
5,946 |
$344K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,145 |
2,934 |
$288K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,238 |
2,063 |
$281K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
967 |
801 |
$271K |
| A4554 |
Disposable underpads, all sizes |
6,434 |
6,174 |
$245K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
605 |
539 |
$236K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,793 |
4,586 |
$229K |
| 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 |
1,507 |
1,364 |
$227K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
2,214 |
2,097 |
$216K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
9,996 |
9,618 |
$205K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
2,249 |
2,021 |
$197K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,887 |
1,774 |
$188K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,359 |
1,219 |
$161K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,139 |
1,701 |
$158K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,826 |
1,605 |
$150K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,637 |
1,473 |
$139K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,258 |
1,191 |
$129K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
8,231 |
7,740 |
$120K |
| A4553 |
Non-disposable underpads, all sizes |
2,376 |
2,287 |
$119K |
| B4100 |
Food thickener, administered orally, per ounce |
1,352 |
1,015 |
$109K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,587 |
3,262 |
$109K |
| 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 |
755 |
654 |
$106K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
6,625 |
5,293 |
$100K |
| 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 |
257 |
231 |
$95K |
| 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 |
478 |
415 |
$89K |
| A7000 |
Canister, disposable, used with suction pump, each |
6,152 |
5,755 |
$87K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
5,904 |
5,473 |
$85K |
| A4452 |
Tape, waterproof, per 18 square inches |
10,842 |
10,068 |
$79K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
497 |
452 |
$78K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
900 |
760 |
$75K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
6,691 |
6,334 |
$68K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
679 |
654 |
$64K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,381 |
1,250 |
$57K |
| A4481 |
Tracheostoma filter, any type, any size, each |
185 |
163 |
$42K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
416 |
380 |
$42K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
983 |
918 |
$42K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,105 |
4,777 |
$42K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
327 |
303 |
$39K |
| 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 |
583 |
550 |
$39K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
312 |
290 |
$30K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,268 |
1,179 |
$28K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
505 |
442 |
$28K |
| L8501 |
Tracheostomy speaking valve |
305 |
286 |
$25K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,863 |
2,672 |
$24K |
| E0601 |
Continuous positive airway pressure (cpap) device |
456 |
354 |
$24K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
1,061 |
863 |
$24K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
3,478 |
3,273 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
1,062 |
942 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
783 |
658 |
$14K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,980 |
3,690 |
$12K |
| S8186 |
Swivel adapter |
760 |
613 |
$12K |
| A4245 |
Alcohol wipes, per box |
1,390 |
1,337 |
$12K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
304 |
268 |
$10K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
825 |
787 |
$9K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
241 |
234 |
$9K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
54 |
38 |
$7K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
313 |
254 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
568 |
451 |
$5K |
| A4402 |
Lubricant, per ounce |
605 |
561 |
$5K |
| A4332 |
Lubricant, individual sterile packet, each |
2,663 |
2,519 |
$4K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
59 |
39 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,588 |
1,383 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
919 |
858 |
$4K |
| A7012 |
Water collection device, used with large volume nebulizer |
560 |
450 |
$3K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
68 |
62 |
$3K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
134 |
123 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
398 |
368 |
$3K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
26 |
24 |
$3K |
| 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 |
16 |
12 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,916 |
1,721 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$2K |
| A7525 |
Tracheostomy mask, each |
461 |
373 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
313 |
291 |
$1K |
| A4244 |
Alcohol or peroxide, per pint |
927 |
846 |
$1K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
108 |
106 |
$574.97 |
| E0776 |
Iv pole |
38 |
36 |
$483.53 |