| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1559 |
Injection, immune globulin (hizentra), 100 mg |
1,885 |
839 |
$1.96M |
| 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 |
1,515 |
956 |
$644K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,742 |
3,934 |
$609K |
| 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 |
1,096 |
789 |
$518K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
3,553 |
1,434 |
$386K |
| 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 |
1,372 |
989 |
$352K |
| 99601 |
|
3,640 |
1,207 |
$326K |
| 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 |
2,374 |
1,262 |
$308K |
| 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 |
2,296 |
1,419 |
$236K |
| 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 |
1,862 |
1,308 |
$203K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,247 |
581 |
$141K |
| B9998 |
Noc for enteral supplies |
1,366 |
1,231 |
$116K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,242 |
1,164 |
$116K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
6,693 |
3,181 |
$114K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,569 |
1,488 |
$81K |
| 99602 |
Nursing care in home rn |
557 |
281 |
$56K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
687 |
593 |
$40K |
| 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 |
592 |
477 |
$30K |
| J3490 |
Unclassified drugs |
113 |
25 |
$12K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
117 |
13 |
$8K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
2,416 |
1,184 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
92 |
75 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
17 |
12 |
$2K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
39 |
12 |
$1K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
399 |
91 |
$1K |
| J7050 |
Infusion, normal saline solution, 250 cc |
22 |
13 |
$77.00 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
58 |
24 |
$49.35 |