| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,079 |
769 |
$715K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
938 |
895 |
$491K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,103 |
6,864 |
$410K |
| A4554 |
Disposable underpads, all sizes |
2,118 |
1,977 |
$263K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,385 |
4,282 |
$255K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,462 |
6,989 |
$227K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,530 |
1,476 |
$199K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,038 |
4,928 |
$195K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,857 |
2,741 |
$174K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,690 |
4,523 |
$116K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
959 |
916 |
$115K |
| 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 |
4,632 |
4,510 |
$112K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,554 |
5,217 |
$104K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,281 |
1,149 |
$89K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,995 |
1,963 |
$79K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,235 |
2,171 |
$73K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
520 |
494 |
$60K |
| A4927 |
Gloves, non-sterile, per 100 |
4,111 |
3,495 |
$58K |
| A7035 |
Headgear used with positive airway pressure device |
4,040 |
3,939 |
$52K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
11,064 |
10,773 |
$42K |
| E0570 |
Nebulizer, with compressor |
1,803 |
1,705 |
$36K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
799 |
783 |
$32K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,719 |
2,660 |
$23K |
| A7526 |
Tracheostomy tube collar/holder, each |
271 |
256 |
$21K |
| 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) |
186 |
175 |
$15K |
| 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 |
103 |
96 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
582 |
552 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
739 |
662 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
1,415 |
1,383 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,126 |
1,047 |
$10K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
341 |
330 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
561 |
454 |
$6K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
26 |
26 |
$6K |
| A7000 |
Canister, disposable, used with suction pump, each |
349 |
318 |
$5K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
52 |
52 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
56 |
52 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
407 |
380 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
184 |
183 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
192 |
183 |
$3K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25 |
25 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
95 |
90 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26 |
24 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
643 |
567 |
$3K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
13 |
$2K |
| K0001 |
Standard wheelchair |
198 |
187 |
$2K |
| E0156 |
Seat attachment, walker |
194 |
187 |
$1K |
| K0002 |
Standard hemi (low seat) wheelchair |
135 |
111 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
458 |
426 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
393 |
369 |
$1K |
| A4670 |
Automatic blood pressure monitor |
13 |
13 |
$643.26 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
27 |
26 |
$553.83 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
14 |
$65.08 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12 |
12 |
$49.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
88 |
84 |
$31.49 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
54 |
49 |
$3.39 |