| 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 |
20,722 |
20,477 |
$1.51M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,959 |
1,919 |
$837K |
| E0601 |
Continuous positive airway pressure (cpap) device |
9,068 |
8,842 |
$629K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
25,197 |
10,956 |
$398K |
| 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 |
2,307 |
1,149 |
$290K |
| 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 |
14,085 |
6,608 |
$227K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,107 |
3,081 |
$212K |
| 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) |
1,437 |
1,407 |
$204K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,422 |
13,271 |
$200K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,343 |
5,189 |
$194K |
| E0570 |
Nebulizer, with compressor |
5,318 |
5,286 |
$162K |
| 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 |
5,697 |
2,333 |
$146K |
| 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 |
8,502 |
3,762 |
$135K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,445 |
3,338 |
$114K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,768 |
2,759 |
$112K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
180 |
176 |
$94K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
534 |
533 |
$81K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
228 |
222 |
$68K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,600 |
1,580 |
$67K |
| K0001 |
Standard wheelchair |
3,595 |
3,562 |
$66K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
578 |
571 |
$63K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,049 |
2,034 |
$63K |
| A7035 |
Headgear used with positive airway pressure device |
4,692 |
4,646 |
$57K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,480 |
1,469 |
$55K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,071 |
3,043 |
$51K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,764 |
3,573 |
$49K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,870 |
2,692 |
$47K |
| A4623 |
Tracheostomy, inner cannula |
3,258 |
3,022 |
$46K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,031 |
2,591 |
$45K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,810 |
1,740 |
$45K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
826 |
825 |
$41K |
| A7037 |
Tubing used with positive airway pressure device |
3,883 |
3,845 |
$36K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,986 |
2,793 |
$36K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
10,578 |
9,979 |
$30K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
13,480 |
12,642 |
$26K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,215 |
1,139 |
$25K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
627 |
576 |
$23K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,498 |
1,417 |
$19K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
952 |
885 |
$16K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,490 |
2,312 |
$15K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,072 |
922 |
$15K |
| E0776 |
Iv pole |
9,937 |
9,827 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,236 |
1,227 |
$12K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
873 |
438 |
$12K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,743 |
1,648 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,883 |
4,753 |
$11K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
25 |
25 |
$10K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
75 |
60 |
$10K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,237 |
1,225 |
$9K |
| E1392 |
Portable oxygen concentrator, rental |
310 |
308 |
$9K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
281 |
280 |
$9K |
| E0156 |
Seat attachment, walker |
854 |
848 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
202 |
170 |
$7K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
11,979 |
11,286 |
$7K |
| 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 |
1,505 |
899 |
$7K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
323 |
305 |
$7K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
539 |
502 |
$6K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
128 |
126 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,170 |
1,146 |
$6K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
368 |
366 |
$6K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
296 |
279 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,824 |
3,619 |
$5K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,112 |
2,095 |
$5K |
| K0002 |
Standard hemi (low seat) wheelchair |
229 |
227 |
$5K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
634 |
608 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,556 |
1,456 |
$4K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
255 |
244 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,361 |
1,274 |
$3K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
993 |
929 |
$3K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
262 |
249 |
$3K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
33 |
31 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
129 |
129 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
31 |
30 |
$3K |
| E0271 |
Mattress, innerspring |
140 |
140 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
444 |
361 |
$2K |
| A4554 |
Disposable underpads, all sizes |
44 |
39 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
249 |
222 |
$2K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
13 |
13 |
$2K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
31 |
28 |
$2K |
| 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) |
13 |
13 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
24 |
24 |
$1K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
246 |
104 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
426 |
393 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$986.88 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
30 |
27 |
$970.48 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
484 |
483 |
$936.89 |
| E1399 |
Durable medical equipment, miscellaneous |
15 |
12 |
$854.82 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
26 |
24 |
$811.48 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
108 |
103 |
$785.73 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
486 |
474 |
$638.11 |
| L8501 |
Tracheostomy speaking valve |
92 |
92 |
$616.16 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
134 |
131 |
$548.05 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
170 |
165 |
$491.52 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
74 |
74 |
$442.81 |
| A6252 |
Specialty absorptive 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 |
119 |
91 |
$399.63 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
36 |
14 |
$288.17 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
54 |
53 |
$278.54 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
12 |
12 |
$240.94 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
13 |
12 |
$232.60 |
| A4371 |
Ostomy skin barrier, powder, per oz |
442 |
404 |
$230.51 |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
115 |
108 |
$212.02 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
25 |
25 |
$173.15 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
74 |
74 |
$136.19 |
| A4367 |
Ostomy belt, each |
107 |
102 |
$130.95 |
| A4354 |
Insertion tray with drainage bag but without catheter |
120 |
112 |
$59.74 |
| A4456 |
Adhesive remover, wipes, any type, each |
12 |
12 |
$32.34 |