| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
15,557 |
7,971 |
$3.88M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
53,205 |
15,418 |
$3.63M |
| E1399 |
Durable medical equipment, miscellaneous |
4,552 |
1,557 |
$2.84M |
| 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 |
28,283 |
17,449 |
$2.78M |
| B9998 |
Noc for enteral supplies |
37,912 |
6,852 |
$2.39M |
| 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 |
7,527 |
5,689 |
$2.22M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,459 |
2,068 |
$2.14M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
4,010 |
3,226 |
$2.09M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
8,445 |
7,497 |
$2.06M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18,097 |
16,432 |
$1.60M |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
25,818 |
12,782 |
$1.44M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
5,562 |
1,588 |
$1.12M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
7,166 |
6,272 |
$963K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
8,844 |
8,356 |
$922K |
| 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) |
3,038 |
2,798 |
$877K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
6,278 |
5,886 |
$804K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,982 |
1,709 |
$766K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
29,891 |
7,613 |
$688K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,497 |
5,114 |
$686K |
| 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 |
9,614 |
4,438 |
$654K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,959 |
4,402 |
$645K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
641 |
538 |
$629K |
| A4312 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
23,104 |
2,171 |
$599K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,631 |
1,444 |
$589K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,015 |
1,289 |
$566K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
3,912 |
1,651 |
$564K |
| 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 |
3,386 |
1,800 |
$553K |
| 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 |
2,391 |
985 |
$552K |
| 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 |
6,324 |
3,511 |
$540K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,399 |
1,088 |
$531K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,772 |
5,010 |
$509K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,831 |
6,374 |
$482K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
885 |
782 |
$477K |
| T4541 |
Incontinence product, disposable underpad, large, each |
11,279 |
10,646 |
$419K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,444 |
3,844 |
$370K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,483 |
2,344 |
$353K |
| 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 |
7,313 |
6,781 |
$311K |
| Y2032 |
|
906 |
812 |
$305K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,804 |
3,639 |
$296K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
3,049 |
2,690 |
$286K |
| 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 |
6,382 |
5,057 |
$271K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,354 |
2,225 |
$265K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
696 |
644 |
$260K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,598 |
2,350 |
$259K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,755 |
7,268 |
$253K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
3,024 |
1,875 |
$247K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,772 |
1,562 |
$243K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,937 |
2,756 |
$231K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,921 |
1,800 |
$231K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,406 |
2,011 |
$221K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,710 |
2,378 |
$216K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
16,030 |
1,031 |
$215K |
| A4927 |
Gloves, non-sterile, per 100 |
5,331 |
4,744 |
$183K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,246 |
890 |
$171K |
| K0003 |
Lightweight wheelchair |
2,235 |
2,185 |
$169K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,508 |
2,377 |
$166K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,628 |
875 |
$155K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,390 |
3,132 |
$148K |
| E0570 |
Nebulizer, with compressor |
1,568 |
1,472 |
$147K |
| B4224 |
Parenteral nutrition administration kit, per day |
5,059 |
281 |
$141K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
6,811 |
3,019 |
$130K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
3,301 |
2,653 |
$124K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
1,561 |
1,097 |
$116K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,054 |
1,016 |
$109K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,959 |
4,427 |
$108K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,030 |
882 |
$107K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
780 |
736 |
$104K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
630 |
591 |
$102K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
412 |
238 |
$101K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,945 |
2,433 |
$100K |
| A4217 |
Sterile water/saline, 500 ml |
1,519 |
1,260 |
$99K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,024 |
2,220 |
$87K |
| K0040 |
Adjustable angle footplate, each |
832 |
562 |
$86K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
7,415 |
3,006 |
$80K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,103 |
548 |
$80K |
| K0001 |
Standard wheelchair |
1,672 |
1,549 |
$79K |
| B4100 |
Food thickener, administered orally, per ounce |
1,181 |
847 |
$73K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
482 |
319 |
$72K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
526 |
509 |
$65K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,404 |
1,898 |
$60K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
533 |
442 |
$60K |
| A7002 |
Tubing, used with suction pump, each |
5,049 |
4,709 |
$59K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,260 |
3,567 |
$57K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,862 |
1,295 |
$57K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
1,868 |
242 |
$55K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
494 |
435 |
$55K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
4,743 |
261 |
$42K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,583 |
1,342 |
$39K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
508 |
500 |
$39K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
618 |
492 |
$38K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,007 |
983 |
$35K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
398 |
358 |
$30K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
505 |
401 |
$30K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
580 |
555 |
$29K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,423 |
1,286 |
$28K |
| A4332 |
Lubricant, individual sterile packet, each |
2,176 |
1,847 |
$27K |
| E0776 |
Iv pole |
2,608 |
2,153 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
303 |
275 |
$24K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
237 |
173 |
$20K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
89 |
43 |
$18K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
335 |
306 |
$17K |
| S9340 |
Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
16 |
16 |
$16K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
663 |
578 |
$15K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,470 |
2,085 |
$15K |
| A4452 |
Tape, waterproof, per 18 square inches |
584 |
508 |
$10K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
218 |
199 |
$10K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
14 |
12 |
$10K |
| E0950 |
Wheelchair accessory, tray, each |
168 |
126 |
$10K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
91 |
76 |
$9K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
179 |
68 |
$9K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,599 |
1,401 |
$7K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
56 |
54 |
$7K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
418 |
374 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
263 |
252 |
$6K |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
14 |
12 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
594 |
548 |
$4K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
18 |
13 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,332 |
1,121 |
$4K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
218 |
198 |
$4K |
| B4081 |
Nasogastric tubing with stylet |
182 |
95 |
$4K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
1,399 |
756 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
102 |
96 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
27 |
26 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
725 |
542 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
45 |
40 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
168 |
158 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
36 |
27 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
13 |
12 |
$1K |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
20 |
14 |
$994.17 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
49 |
39 |
$682.63 |
| A7525 |
Tracheostomy mask, each |
446 |
199 |
$670.79 |
| K0038 |
Leg strap, each |
36 |
25 |
$665.18 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
226 |
202 |
$628.61 |
| A4402 |
Lubricant, per ounce |
43 |
38 |
$144.76 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
25 |
25 |
$69.15 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
14 |
12 |
$67.96 |
| A4456 |
Adhesive remover, wipes, any type, each |
14 |
13 |
$55.52 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
63 |
54 |
$31.14 |