| 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 |
19,594 |
12,255 |
$601K |
| E0601 |
Continuous positive airway pressure (cpap) device |
10,265 |
8,037 |
$228K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,596 |
2,077 |
$153K |
| E0570 |
Nebulizer, with compressor |
6,940 |
5,546 |
$135K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,242 |
8,428 |
$124K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
6,828 |
3,908 |
$85K |
| K0001 |
Standard wheelchair |
8,601 |
4,866 |
$64K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,523 |
6,317 |
$60K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,594 |
2,002 |
$59K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,095 |
1,634 |
$52K |
| A7035 |
Headgear used with positive airway pressure device |
3,896 |
3,162 |
$45K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,274 |
968 |
$41K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
7,009 |
3,640 |
$27K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,352 |
725 |
$24K |
| E1392 |
Portable oxygen concentrator, rental |
1,793 |
1,075 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,897 |
4,789 |
$22K |
| 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) |
785 |
580 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
1,947 |
1,598 |
$20K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,296 |
1,020 |
$14K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,013 |
484 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
478 |
384 |
$14K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,225 |
1,299 |
$13K |
| K0006 |
Heavy duty wheelchair |
982 |
481 |
$12K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
889 |
467 |
$10K |
| K0003 |
Lightweight wheelchair |
2,193 |
1,067 |
$9K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
851 |
696 |
$6K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,359 |
730 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
7,394 |
1,902 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,606 |
1,338 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
4,520 |
1,180 |
$4K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
398 |
177 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,654 |
393 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
362 |
165 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,354 |
1,145 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
109 |
79 |
$1K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,138 |
994 |
$549.18 |
| K0007 |
Extra heavy duty wheelchair |
56 |
24 |
$418.65 |
| E2202 |
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
36 |
13 |
$386.88 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
13 |
13 |
$301.01 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
55 |
26 |
$284.70 |