| 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 |
72,755 |
62,485 |
$1.50M |
| E0601 |
Continuous positive airway pressure (cpap) device |
12,093 |
10,947 |
$186K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,886 |
5,876 |
$175K |
| E0570 |
Nebulizer, with compressor |
10,637 |
9,443 |
$128K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
9,310 |
8,046 |
$110K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
25,265 |
21,698 |
$109K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
8,095 |
6,952 |
$91K |
| E1392 |
Portable oxygen concentrator, rental |
17,695 |
14,944 |
$90K |
| K0001 |
Standard wheelchair |
14,115 |
12,266 |
$84K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,469 |
3,912 |
$74K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
14,406 |
12,960 |
$71K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
914 |
818 |
$65K |
| 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) |
1,838 |
1,617 |
$61K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
1,558 |
1,427 |
$59K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
530 |
329 |
$38K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,184 |
3,538 |
$37K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
3,431 |
1,969 |
$36K |
| A7035 |
Headgear used with positive airway pressure device |
6,070 |
5,231 |
$33K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
3,456 |
1,981 |
$33K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,971 |
1,808 |
$23K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,742 |
1,561 |
$21K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,046 |
1,790 |
$19K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12,446 |
10,753 |
$19K |
| K0006 |
Heavy duty wheelchair |
839 |
724 |
$15K |
| A7037 |
Tubing used with positive airway pressure device |
3,002 |
2,620 |
$12K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,675 |
6,919 |
$9K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
427 |
326 |
$8K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
776 |
654 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,527 |
2,156 |
$8K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,193 |
1,008 |
$7K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
46 |
27 |
$7K |
| K0007 |
Extra heavy duty wheelchair |
185 |
160 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,628 |
1,452 |
$5K |
| E0156 |
Seat attachment, walker |
1,685 |
1,488 |
$4K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
107 |
85 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
6,244 |
5,607 |
$3K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
70 |
63 |
$2K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
12 |
12 |
$2K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
65 |
49 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
342 |
296 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
814 |
645 |
$2K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
671 |
609 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
14 |
14 |
$975.83 |
| K0003 |
Lightweight wheelchair |
73 |
65 |
$930.04 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
125 |
99 |
$864.31 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
220 |
100 |
$859.86 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
41 |
31 |
$854.71 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
27 |
25 |
$660.87 |
| A7036 |
Chinstrap used with positive airway pressure device |
97 |
87 |
$235.37 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
80 |
66 |
$106.40 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
24 |
24 |
$66.18 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
12 |
12 |
$19.49 |