| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
24,088 |
22,612 |
$8.08M |
| 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 |
9,623 |
9,105 |
$4.47M |
| 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 |
5,149 |
4,799 |
$2.96M |
| 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 |
12,194 |
11,546 |
$2.44M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,251 |
3,194 |
$2.26M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,874 |
1,247 |
$1.81M |
| 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 |
1,282 |
1,206 |
$1.08M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,798 |
6,657 |
$1.07M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
9,320 |
9,170 |
$1.02M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,335 |
5,219 |
$861K |
| B9002 |
Enteral nutrition infusion pump, any type |
6,534 |
6,430 |
$841K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,207 |
3,067 |
$804K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
5,057 |
4,934 |
$773K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,132 |
3,932 |
$759K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
7,826 |
3,244 |
$708K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,988 |
3,877 |
$644K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,408 |
1,399 |
$632K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,785 |
2,624 |
$609K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,914 |
3,811 |
$595K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
12,809 |
12,639 |
$534K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,827 |
5,759 |
$497K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
1,716 |
1,610 |
$435K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,488 |
2,424 |
$432K |
| 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 |
1,717 |
1,634 |
$403K |
| A4605 |
Tracheal suction catheter, closed system, each |
976 |
940 |
$387K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,297 |
1,237 |
$356K |
| 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 |
988 |
903 |
$347K |
| 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 |
1,444 |
1,385 |
$306K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,930 |
1,798 |
$238K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,356 |
1,312 |
$232K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,241 |
2,140 |
$218K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,324 |
1,245 |
$200K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,784 |
2,716 |
$178K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,460 |
8,277 |
$156K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
576 |
551 |
$151K |
| 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 |
2,617 |
2,484 |
$151K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,010 |
960 |
$149K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,023 |
996 |
$141K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,365 |
4,225 |
$140K |
| A4927 |
Gloves, non-sterile, per 100 |
6,480 |
6,150 |
$138K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
207 |
189 |
$112K |
| E0618 |
Apnea monitor, without recording feature |
384 |
373 |
$109K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,502 |
1,483 |
$96K |
| A4217 |
Sterile water/saline, 500 ml |
1,173 |
1,026 |
$92K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,699 |
1,604 |
$85K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,932 |
1,901 |
$83K |
| 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) |
220 |
220 |
$65K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
203 |
109 |
$58K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,053 |
1,002 |
$54K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
1,524 |
1,463 |
$52K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
875 |
844 |
$50K |
| E0601 |
Continuous positive airway pressure (cpap) device |
997 |
993 |
$49K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,947 |
613 |
$49K |
| E0570 |
Nebulizer, with compressor |
698 |
690 |
$49K |
| E1399 |
Durable medical equipment, miscellaneous |
1,030 |
827 |
$48K |
| A7002 |
Tubing, used with suction pump, each |
4,633 |
4,475 |
$47K |
| L8501 |
Tracheostomy speaking valve |
425 |
413 |
$45K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
686 |
663 |
$42K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,918 |
3,785 |
$41K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,170 |
2,130 |
$41K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
233 |
218 |
$40K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
157 |
154 |
$36K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,085 |
847 |
$32K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
415 |
408 |
$29K |
| B4224 |
Parenteral nutrition administration kit, per day |
140 |
36 |
$29K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
565 |
473 |
$24K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
142 |
131 |
$23K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
230 |
224 |
$22K |
| A4332 |
Lubricant, individual sterile packet, each |
1,641 |
1,595 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,430 |
2,808 |
$21K |
| B9004 |
Parenteral nutrition infusion pump, portable |
186 |
48 |
$20K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
265 |
257 |
$19K |
| E0776 |
Iv pole |
153 |
151 |
$16K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
330 |
313 |
$15K |
| A7037 |
Tubing used with positive airway pressure device |
579 |
565 |
$15K |
| B4178 |
Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix |
42 |
12 |
$13K |
| K0001 |
Standard wheelchair |
589 |
581 |
$13K |
| A4402 |
Lubricant, per ounce |
1,498 |
1,480 |
$12K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
230 |
218 |
$12K |
| E0480 |
Percussor, electric or pneumatic, home model |
311 |
311 |
$12K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,211 |
608 |
$12K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,224 |
1,199 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
85 |
81 |
$10K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
67 |
67 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,937 |
1,894 |
$9K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
42 |
12 |
$9K |
| A5120 |
Skin barrier, wipes or swabs, each |
750 |
513 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
91 |
89 |
$7K |
| B4222 |
Parenteral nutrition supply kit; home mix, per day |
83 |
24 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
217 |
195 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
479 |
426 |
$6K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
779 |
750 |
$6K |
| B4180 |
Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix |
41 |
12 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
280 |
275 |
$4K |
| A7525 |
Tracheostomy mask, each |
638 |
596 |
$4K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
27 |
25 |
$3K |
| B4082 |
Nasogastric tubing without stylet |
158 |
149 |
$3K |
| B4216 |
Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day |
41 |
12 |
$3K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
170 |
162 |
$2K |
| A4670 |
Automatic blood pressure monitor |
23 |
23 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
143 |
132 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
14 |
13 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
644 |
249 |
$2K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
39 |
38 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
105 |
87 |
$1K |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
26 |
26 |
$899.98 |
| 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 |
12 |
12 |
$725.00 |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
14 |
14 |
$722.78 |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
24 |
15 |
$662.22 |
| A7015 |
Aerosol mask, used with dme nebulizer |
498 |
452 |
$646.55 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$622.56 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
54 |
25 |
$619.74 |
| A4322 |
Irrigation syringe, bulb or piston, each |
31 |
31 |
$201.92 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13 |
12 |
$108.76 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
13 |
13 |
$48.10 |
| A4458 |
Enema bag with tubing, reusable |
12 |
12 |
$0.00 |