| 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 |
35,070 |
25,609 |
$903K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,229 |
7,159 |
$644K |
| 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 |
1,235 |
1,037 |
$637K |
| 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 |
3,076 |
2,674 |
$593K |
| 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 |
7,526 |
5,974 |
$586K |
| 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 |
828 |
663 |
$238K |
| 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 |
3,282 |
2,529 |
$217K |
| B9998 |
Noc for enteral supplies |
3,966 |
2,641 |
$209K |
| 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 |
681 |
581 |
$182K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,953 |
2,907 |
$141K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,259 |
2,753 |
$124K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
19,445 |
14,752 |
$118K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,889 |
3,646 |
$117K |
| E1392 |
Portable oxygen concentrator, rental |
7,705 |
6,094 |
$116K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,361 |
964 |
$105K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,112 |
3,435 |
$65K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,701 |
2,274 |
$65K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,567 |
2,331 |
$63K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,776 |
1,606 |
$50K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
237 |
156 |
$48K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
717 |
586 |
$46K |
| E0570 |
Nebulizer, with compressor |
5,401 |
4,321 |
$40K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,868 |
4,042 |
$38K |
| 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 |
1,668 |
1,436 |
$35K |
| A7035 |
Headgear used with positive airway pressure device |
3,519 |
3,095 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,079 |
968 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
3,358 |
2,872 |
$18K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,897 |
2,530 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,494 |
8,254 |
$16K |
| E0776 |
Iv pole |
2,706 |
2,338 |
$14K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,697 |
2,406 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
606 |
549 |
$9K |
| 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) |
260 |
174 |
$9K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
185 |
174 |
$4K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
26 |
25 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
719 |
608 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
119 |
99 |
$3K |
| K0001 |
Standard wheelchair |
142 |
115 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
275 |
205 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,052 |
882 |
$391.61 |
| A7015 |
Aerosol mask, used with dme nebulizer |
432 |
372 |
$251.35 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
135 |
119 |
$41.45 |