| 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 |
26,199 |
24,391 |
$976K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,629 |
4,167 |
$905K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,886 |
3,667 |
$884K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,685 |
1,614 |
$832K |
| 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 |
1,030 |
853 |
$579K |
| 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 |
2,519 |
2,063 |
$268K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,077 |
1,023 |
$208K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,419 |
1,298 |
$202K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,321 |
2,109 |
$161K |
| A4217 |
Sterile water/saline, 500 ml |
2,067 |
1,859 |
$154K |
| E0570 |
Nebulizer, with compressor |
3,376 |
3,197 |
$139K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,347 |
1,194 |
$113K |
| 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 |
239 |
181 |
$105K |
| E1392 |
Portable oxygen concentrator, rental |
7,493 |
7,021 |
$93K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12,286 |
11,382 |
$93K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,452 |
5,929 |
$90K |
| B9998 |
Noc for enteral supplies |
1,195 |
860 |
$82K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
585 |
560 |
$68K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
251 |
221 |
$61K |
| 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 |
982 |
780 |
$49K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
913 |
829 |
$45K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,257 |
1,163 |
$38K |
| K0001 |
Standard wheelchair |
3,102 |
2,794 |
$37K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,835 |
4,468 |
$32K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,214 |
3,039 |
$32K |
| A4605 |
Tracheal suction catheter, closed system, each |
884 |
817 |
$32K |
| A7002 |
Tubing, used with suction pump, each |
3,326 |
3,061 |
$28K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,430 |
2,227 |
$22K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
342 |
324 |
$21K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
177 |
158 |
$19K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,873 |
1,794 |
$16K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
716 |
672 |
$16K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,411 |
1,280 |
$12K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,499 |
1,385 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
2,444 |
2,325 |
$11K |
| 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) |
98 |
83 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,904 |
1,797 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,440 |
3,207 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
634 |
500 |
$7K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
52 |
49 |
$7K |
| 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) |
235 |
215 |
$6K |
| 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 |
46 |
39 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
461 |
430 |
$6K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
261 |
253 |
$5K |
| E1399 |
Durable medical equipment, miscellaneous |
188 |
128 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
657 |
629 |
$4K |
| B9002 |
Enteral nutrition infusion pump, any type |
25 |
24 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
1,672 |
1,618 |
$3K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
16 |
12 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
982 |
923 |
$2K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
1,508 |
1,427 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
44 |
40 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
271 |
260 |
$2K |
| A4657 |
Syringe, with or without needle, each |
603 |
539 |
$2K |
| 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 |
38 |
25 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
561 |
548 |
$803.99 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
173 |
166 |
$472.65 |
| A7525 |
Tracheostomy mask, each |
53 |
43 |
$185.17 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
13 |
13 |
$166.20 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
15 |
12 |
$148.04 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
956 |
894 |
$19.86 |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
113 |
105 |
$0.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$0.00 |