| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
3,554 |
476 |
$2.45M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
21,767 |
18,981 |
$642K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,315 |
3,317 |
$519K |
| 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 |
3,072 |
2,410 |
$502K |
| 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 |
3,720 |
2,773 |
$287K |
| 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 |
1,135 |
782 |
$258K |
| 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 |
11,710 |
573 |
$233K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,587 |
2,715 |
$223K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,210 |
5,100 |
$200K |
| 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 |
2,645 |
1,719 |
$186K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,663 |
1,438 |
$170K |
| E0570 |
Nebulizer, with compressor |
17,340 |
15,354 |
$150K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,119 |
6,141 |
$140K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,619 |
15,449 |
$119K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,310 |
3,760 |
$75K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
858 |
723 |
$69K |
| K0001 |
Standard wheelchair |
7,342 |
6,378 |
$59K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
440 |
371 |
$53K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,366 |
6,119 |
$53K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,273 |
2,066 |
$51K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,185 |
596 |
$48K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
170 |
166 |
$47K |
| 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 |
558 |
417 |
$46K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,642 |
3,043 |
$41K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
2,111 |
1,709 |
$39K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
646 |
458 |
$39K |
| 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) |
1,267 |
1,118 |
$38K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
621 |
521 |
$35K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,897 |
1,715 |
$35K |
| A7037 |
Tubing used with positive airway pressure device |
5,819 |
4,959 |
$33K |
| A7035 |
Headgear used with positive airway pressure device |
4,547 |
3,779 |
$33K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,189 |
1,894 |
$32K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,903 |
1,694 |
$29K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,263 |
1,085 |
$29K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,883 |
2,292 |
$28K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,206 |
881 |
$27K |
| K0006 |
Heavy duty wheelchair |
1,199 |
1,081 |
$25K |
| S9542 |
Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
3,563 |
480 |
$23K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
230 |
182 |
$23K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,283 |
1,087 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,739 |
9,038 |
$19K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
820 |
619 |
$17K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
30 |
24 |
$17K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
50 |
41 |
$15K |
| 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 |
1,200 |
1,055 |
$14K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
965 |
723 |
$14K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
386 |
38 |
$13K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
893 |
834 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,926 |
2,461 |
$11K |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
1,433 |
241 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,546 |
2,158 |
$11K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
116 |
103 |
$10K |
| A4623 |
Tracheostomy, inner cannula |
162 |
129 |
$9K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
3,317 |
2,807 |
$8K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
113 |
24 |
$8K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,636 |
794 |
$8K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,944 |
1,632 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
2,364 |
1,955 |
$7K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
174 |
152 |
$7K |
| S5502 |
Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) |
946 |
706 |
$6K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
44 |
26 |
$6K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
107 |
102 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
352 |
297 |
$4K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
412 |
327 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,191 |
1,888 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,086 |
753 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
127 |
38 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
85 |
77 |
$2K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
45 |
14 |
$2K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
24 |
12 |
$1K |
| J1644 |
Injection, heparin sodium, per 1000 units |
329 |
198 |
$982.34 |
| A7504 |
Filter for use in a tracheostoma heat and moisture exchange system, each |
62 |
51 |
$836.70 |
| A7012 |
Water collection device, used with large volume nebulizer |
233 |
182 |
$790.48 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
125 |
105 |
$543.04 |
| E0202 |
Phototherapy (bilirubin) light with photometer |
16 |
12 |
$459.71 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
13 |
12 |
$373.49 |
| J7050 |
Infusion, normal saline solution, 250 cc |
682 |
357 |
$282.28 |
| A7525 |
Tracheostomy mask, each |
272 |
221 |
$233.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
182 |
158 |
$138.03 |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
16 |
12 |
$115.80 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
85 |
56 |
$94.40 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
26 |
12 |
$54.32 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
64 |
45 |
$51.10 |
| 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 |
26 |
12 |
$44.36 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
15 |
13 |
$6.57 |