| 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 |
7,677 |
6,038 |
$411K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,976 |
4,213 |
$376K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,873 |
5,774 |
$256K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,100 |
3,391 |
$197K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,306 |
1,113 |
$168K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,805 |
5,615 |
$130K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,430 |
3,629 |
$117K |
| A7035 |
Headgear used with positive airway pressure device |
5,301 |
4,595 |
$101K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,923 |
1,662 |
$99K |
| A7037 |
Tubing used with positive airway pressure device |
3,677 |
3,355 |
$89K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
580 |
388 |
$38K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
317 |
253 |
$31K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,207 |
6,011 |
$29K |
| E0570 |
Nebulizer, with compressor |
2,393 |
2,066 |
$26K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,941 |
3,424 |
$24K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
200 |
157 |
$17K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
623 |
541 |
$17K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,795 |
2,261 |
$16K |
| 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) |
276 |
227 |
$14K |
| 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 |
2,061 |
1,707 |
$13K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
229 |
140 |
$12K |
| K0001 |
Standard wheelchair |
675 |
606 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
277 |
253 |
$7K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
475 |
396 |
$7K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
39 |
30 |
$5K |
| 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 |
66 |
54 |
$5K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
91 |
77 |
$5K |
| A7000 |
Canister, disposable, used with suction pump, each |
577 |
477 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
240 |
221 |
$3K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
87 |
77 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
123 |
102 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
323 |
276 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
201 |
155 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
606 |
507 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
27 |
25 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
192 |
157 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
101 |
90 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
12 |
12 |
$2K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
14 |
13 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
51 |
43 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
288 |
253 |
$1K |
| A7526 |
Tracheostomy tube collar/holder, each |
12 |
12 |
$929.59 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$716.90 |
| B9002 |
Enteral nutrition infusion pump, any type |
13 |
12 |
$614.95 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
84 |
82 |
$523.22 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
13 |
12 |
$316.66 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
25 |
25 |
$282.30 |
| A4456 |
Adhesive remover, wipes, any type, each |
24 |
14 |
$90.40 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
43 |
40 |
$84.21 |
| A7015 |
Aerosol mask, used with dme nebulizer |
74 |
71 |
$57.91 |
| A4402 |
Lubricant, per ounce |
27 |
25 |
$35.92 |