| 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 |
8,666 |
7,391 |
$1.18M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,108 |
7,040 |
$745K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
24,955 |
20,500 |
$652K |
| B9998 |
Noc for enteral supplies |
7,223 |
5,338 |
$481K |
| 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 |
6,795 |
5,725 |
$451K |
| S5170 |
Home delivered meals, including preparation; per meal |
1,898 |
1,657 |
$274K |
| 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 |
4,219 |
3,577 |
$274K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,962 |
2,527 |
$264K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,687 |
1,560 |
$210K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,912 |
2,461 |
$194K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,707 |
1,594 |
$189K |
| E0570 |
Nebulizer, with compressor |
2,933 |
2,732 |
$151K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,103 |
1,969 |
$148K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
5,881 |
4,647 |
$138K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,006 |
1,668 |
$117K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,781 |
1,540 |
$111K |
| S8490 |
Insulin syringes (100 syringes, any size) |
3,251 |
2,960 |
$103K |
| 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 |
3,942 |
3,424 |
$90K |
| 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 |
644 |
469 |
$77K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,724 |
2,547 |
$50K |
| 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 |
243 |
223 |
$47K |
| 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 |
163 |
100 |
$41K |
| A7035 |
Headgear used with positive airway pressure device |
1,616 |
1,528 |
$39K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
887 |
772 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
634 |
616 |
$31K |
| 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) |
218 |
197 |
$29K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
585 |
565 |
$28K |
| 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 |
1,583 |
1,354 |
$25K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
115 |
111 |
$25K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,065 |
1,038 |
$24K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,512 |
1,343 |
$24K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
246 |
206 |
$16K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
799 |
619 |
$15K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
3,100 |
2,984 |
$15K |
| K0001 |
Standard wheelchair |
512 |
455 |
$13K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,889 |
3,670 |
$8K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
69 |
49 |
$8K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
66 |
63 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
216 |
213 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
1,453 |
1,384 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
43 |
37 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
479 |
456 |
$5K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
257 |
208 |
$4K |
| A4554 |
Disposable underpads, all sizes |
144 |
129 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,959 |
1,812 |
$4K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
3,088 |
2,936 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
33 |
26 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
18 |
13 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
61 |
50 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
41 |
36 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
984 |
909 |
$2K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
12 |
12 |
$952.60 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
422 |
186 |
$910.71 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
33 |
27 |
$509.78 |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
73 |
68 |
$267.80 |
| A5120 |
Skin barrier, wipes or swabs, each |
126 |
111 |
$225.78 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
54 |
49 |
$148.29 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
113 |
93 |
$140.88 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
41 |
36 |
$120.35 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
44 |
37 |
$100.30 |