| 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 |
4,743 |
3,306 |
$376K |
| 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 |
1,437 |
889 |
$370K |
| 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 |
3,732 |
2,283 |
$364K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,851 |
10,193 |
$345K |
| B9998 |
Noc for enteral supplies |
2,641 |
1,801 |
$101K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,242 |
2,132 |
$93K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
376 |
343 |
$91K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,350 |
3,183 |
$82K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,762 |
2,568 |
$70K |
| 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 |
1,424 |
1,014 |
$58K |
| B9002 |
Enteral nutrition infusion pump, any type |
856 |
754 |
$53K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,576 |
1,074 |
$46K |
| 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 |
1,012 |
593 |
$45K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,696 |
6,240 |
$39K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,303 |
3,097 |
$28K |
| A7037 |
Tubing used with positive airway pressure device |
2,770 |
2,649 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,750 |
1,665 |
$16K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,141 |
4,872 |
$15K |
| E0570 |
Nebulizer, with compressor |
3,863 |
3,705 |
$14K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
536 |
455 |
$10K |
| E0776 |
Iv pole |
790 |
728 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
302 |
283 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
270 |
262 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
762 |
684 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
952 |
914 |
$4K |
| 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 |
13 |
12 |
$3K |
| 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) |
69 |
67 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,471 |
1,369 |
$1K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
138 |
135 |
$629.50 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$249.33 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
12 |
$83.87 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
16 |
15 |
$65.55 |
| A7015 |
Aerosol mask, used with dme nebulizer |
57 |
54 |
$31.13 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
14 |
14 |
$13.97 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
56 |
54 |
$0.00 |