| 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 |
14,216 |
14,204 |
$1.32M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
538 |
534 |
$464K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,346 |
8,329 |
$449K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,444 |
3,434 |
$369K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,121 |
2,109 |
$285K |
| 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) |
2,058 |
2,053 |
$256K |
| 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) |
766 |
764 |
$223K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,928 |
4,917 |
$212K |
| E1399 |
Durable medical equipment, miscellaneous |
100 |
88 |
$184K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,403 |
1,403 |
$183K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
896 |
799 |
$182K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,902 |
1,883 |
$172K |
| E0570 |
Nebulizer, with compressor |
15,268 |
15,238 |
$170K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
240 |
240 |
$168K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,733 |
3,702 |
$159K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,089 |
2,033 |
$150K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,621 |
7,615 |
$144K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,055 |
2,052 |
$139K |
| 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 |
1,210 |
884 |
$138K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,423 |
1,406 |
$136K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,589 |
2,571 |
$118K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,085 |
1,076 |
$100K |
| 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 |
347 |
217 |
$82K |
| E1392 |
Portable oxygen concentrator, rental |
2,691 |
2,691 |
$78K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
862 |
859 |
$77K |
| A7035 |
Headgear used with positive airway pressure device |
3,439 |
3,432 |
$76K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
711 |
707 |
$76K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,065 |
1,064 |
$75K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
846 |
830 |
$69K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,456 |
1,441 |
$67K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,900 |
1,866 |
$67K |
| A4217 |
Sterile water/saline, 500 ml |
550 |
452 |
$65K |
| 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 |
160 |
147 |
$63K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
614 |
609 |
$63K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,812 |
2,767 |
$61K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
627 |
622 |
$60K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
111 |
83 |
$60K |
| K0001 |
Standard wheelchair |
2,064 |
2,058 |
$58K |
| A4927 |
Gloves, non-sterile, per 100 |
3,868 |
3,789 |
$56K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
955 |
952 |
$55K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
618 |
569 |
$47K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
585 |
585 |
$42K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
481 |
472 |
$41K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,328 |
2,322 |
$40K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,558 |
6,506 |
$39K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
406 |
391 |
$39K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
377 |
363 |
$35K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
386 |
347 |
$35K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
515 |
509 |
$34K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,229 |
1,222 |
$32K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
465 |
465 |
$30K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,474 |
1,439 |
$29K |
| A4605 |
Tracheal suction catheter, closed system, each |
338 |
325 |
$28K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
27 |
27 |
$27K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
109 |
94 |
$26K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,068 |
2,059 |
$25K |
| A7526 |
Tracheostomy tube collar/holder, each |
504 |
466 |
$25K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
113 |
108 |
$25K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
291 |
289 |
$23K |
| 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 |
251 |
184 |
$22K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
286 |
271 |
$22K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
726 |
723 |
$19K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,036 |
500 |
$16K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
373 |
372 |
$14K |
| A7002 |
Tubing, used with suction pump, each |
1,624 |
1,572 |
$14K |
| K0007 |
Extra heavy duty wheelchair |
98 |
97 |
$13K |
| A4322 |
Irrigation syringe, bulb or piston, each |
263 |
246 |
$13K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
211 |
211 |
$12K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
100 |
95 |
$11K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,420 |
1,250 |
$11K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
110 |
102 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
795 |
791 |
$11K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,715 |
840 |
$11K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
43 |
43 |
$11K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
224 |
208 |
$11K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
212 |
209 |
$10K |
| K0004 |
High strength, lightweight wheelchair |
124 |
124 |
$10K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
306 |
292 |
$10K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
88 |
83 |
$10K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
642 |
642 |
$10K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
71 |
71 |
$9K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
167 |
167 |
$8K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
129 |
127 |
$8K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
154 |
154 |
$8K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
125 |
111 |
$7K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
66 |
40 |
$7K |
| A4623 |
Tracheostomy, inner cannula |
37 |
30 |
$7K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
172 |
166 |
$7K |
| E1372 |
Immersion external heater for nebulizer |
438 |
432 |
$6K |
| A4456 |
Adhesive remover, wipes, any type, each |
455 |
447 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
509 |
456 |
$5K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
104 |
75 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
383 |
342 |
$4K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
463 |
458 |
$4K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
158 |
147 |
$4K |
| K0003 |
Lightweight wheelchair |
65 |
65 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
166 |
166 |
$4K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
49 |
49 |
$3K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
94 |
94 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
143 |
113 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
47 |
47 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
26 |
26 |
$2K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
83 |
80 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
98 |
98 |
$2K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
50 |
50 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
751 |
745 |
$2K |
| E0156 |
Seat attachment, walker |
106 |
106 |
$2K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
27 |
25 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
185 |
174 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,045 |
1,043 |
$1K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
15 |
14 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
107 |
106 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
26 |
25 |
$1K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
73 |
70 |
$1K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
18 |
15 |
$1K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
28 |
18 |
$921.00 |
| A4618 |
Breathing circuits |
66 |
57 |
$859.92 |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
13 |
13 |
$829.35 |
| A4402 |
Lubricant, per ounce |
142 |
139 |
$763.21 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
19 |
17 |
$761.19 |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
29 |
28 |
$712.52 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
63 |
63 |
$614.07 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
42 |
39 |
$588.89 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
15 |
15 |
$552.40 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
27 |
27 |
$380.34 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
218 |
218 |
$318.84 |
| A4371 |
Ostomy skin barrier, powder, per oz |
47 |
46 |
$234.27 |
| B9998 |
Noc for enteral supplies |
13 |
13 |
$193.67 |
| E0776 |
Iv pole |
40 |
40 |
$165.74 |
| A4332 |
Lubricant, individual sterile packet, each |
12 |
12 |
$146.10 |
| A4452 |
Tape, waterproof, per 18 square inches |
15 |
14 |
$105.02 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
16 |
15 |
$71.99 |
| A7012 |
Water collection device, used with large volume nebulizer |
16 |
15 |
$62.96 |
| A4367 |
Ostomy belt, each |
12 |
12 |
$56.42 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
41 |
41 |
$47.29 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
16 |
12 |
$0.00 |