| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
698 |
528 |
$114K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,256 |
2,844 |
$90K |
| 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 |
370 |
319 |
$69K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,317 |
1,641 |
$39K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,071 |
934 |
$34K |
| 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 |
338 |
233 |
$33K |
| A7030 |
Full face mask used with positive airway pressure device, each |
541 |
493 |
$31K |
| 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 |
1,456 |
1,278 |
$28K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
356 |
288 |
$25K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
403 |
344 |
$23K |
| E0570 |
Nebulizer, with compressor |
1,351 |
1,246 |
$22K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
328 |
254 |
$21K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
285 |
263 |
$20K |
| 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 |
150 |
133 |
$17K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
466 |
423 |
$15K |
| 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) |
465 |
334 |
$12K |
| A7035 |
Headgear used with positive airway pressure device |
915 |
834 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
463 |
437 |
$10K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
160 |
133 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
317 |
152 |
$8K |
| K0001 |
Standard wheelchair |
764 |
694 |
$7K |
| A7031 |
Face mask interface, replacement for full face mask, each |
498 |
453 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
364 |
321 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
319 |
269 |
$6K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
120 |
117 |
$6K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
123 |
107 |
$6K |
| A7526 |
Tracheostomy tube collar/holder, each |
169 |
156 |
$6K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
125 |
114 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
44 |
37 |
$5K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
786 |
713 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
472 |
437 |
$3K |
| E0776 |
Iv pole |
251 |
210 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
119 |
105 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
218 |
196 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,158 |
1,025 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
16 |
12 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
133 |
107 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
60 |
54 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
192 |
158 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
305 |
262 |
$852.05 |
| Z0020 |
|
306 |
267 |
$719.00 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
202 |
122 |
$658.58 |
| B4100 |
Food thickener, administered orally, per ounce |
17 |
12 |
$644.30 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
32 |
28 |
$595.86 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
13 |
12 |
$582.18 |
| K0006 |
Heavy duty wheelchair |
29 |
28 |
$401.32 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
100 |
91 |
$275.47 |
| A7002 |
Tubing, used with suction pump, each |
257 |
169 |
$254.91 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
193 |
144 |
$227.44 |
| A4649 |
Surgical supply; miscellaneous |
58 |
50 |
$204.24 |
| A4927 |
Gloves, non-sterile, per 100 |
34 |
27 |
$188.44 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
29 |
28 |
$181.11 |
| E0156 |
Seat attachment, walker |
32 |
29 |
$140.21 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
62 |
58 |
$93.37 |
| A7525 |
Tracheostomy mask, each |
17 |
12 |
$14.70 |
| A7015 |
Aerosol mask, used with dme nebulizer |
15 |
13 |
$0.95 |