| 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 |
1,181 |
842 |
$623K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,498 |
3,709 |
$571K |
| 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 |
4,303 |
2,875 |
$479K |
| 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 |
1,995 |
1,552 |
$348K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
2,864 |
1,122 |
$288K |
| 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 |
1,670 |
1,150 |
$275K |
| 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 |
543 |
414 |
$271K |
| 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 |
2,372 |
1,943 |
$237K |
| B9998 |
Noc for enteral supplies |
1,501 |
1,334 |
$113K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
996 |
941 |
$92K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,356 |
1,176 |
$90K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,339 |
1,249 |
$72K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,767 |
1,589 |
$54K |
| 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 |
114 |
94 |
$36K |
| 99601 |
|
214 |
66 |
$19K |
| 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 |
424 |
375 |
$17K |
| B4224 |
Parenteral nutrition administration kit, per day |
149 |
12 |
$4K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
149 |
12 |
$1K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
44 |
12 |
$980.21 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
23 |
12 |
$21.88 |