| 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 |
8,083 |
7,047 |
$6.55M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
29,211 |
27,272 |
$6.47M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
8,417 |
8,123 |
$5.52M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
28,805 |
27,993 |
$4.15M |
| 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 |
8,354 |
8,018 |
$3.40M |
| B9002 |
Enteral nutrition infusion pump, any type |
44,624 |
43,786 |
$3.29M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
33,251 |
32,390 |
$2.77M |
| B9998 |
Noc for enteral supplies |
30,712 |
28,320 |
$2.43M |
| 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 |
9,967 |
9,713 |
$2.34M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
9,023 |
8,234 |
$2.04M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
14,215 |
13,933 |
$1.44M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
30,394 |
29,415 |
$1.19M |
| A4629 |
Tracheostomy care kit for established tracheostomy |
10,988 |
10,407 |
$902K |
| 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 |
829 |
806 |
$748K |
| E0619 |
Apnea monitor, with recording feature |
4,946 |
4,603 |
$740K |
| 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) |
1,800 |
1,761 |
$634K |
| 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 |
2,899 |
2,786 |
$578K |
| A4554 |
Disposable underpads, all sizes |
12,779 |
12,373 |
$511K |
| E0570 |
Nebulizer, with compressor |
5,505 |
5,438 |
$500K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,279 |
4,071 |
$495K |
| A4927 |
Gloves, non-sterile, per 100 |
22,999 |
22,439 |
$393K |
| 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 |
1,632 |
1,574 |
$378K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
548 |
527 |
$368K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,484 |
3,318 |
$340K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,508 |
2,403 |
$286K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,478 |
2,378 |
$266K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,208 |
4,850 |
$257K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
2,595 |
2,041 |
$253K |
| A7504 |
Filter for use in a tracheostoma heat and moisture exchange system, each |
8,275 |
7,788 |
$214K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13,793 |
13,304 |
$201K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
6,859 |
6,725 |
$193K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,447 |
1,361 |
$187K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
6,850 |
6,687 |
$180K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,371 |
1,325 |
$171K |
| A7002 |
Tubing, used with suction pump, each |
9,367 |
9,217 |
$155K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,204 |
2,946 |
$153K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
1,883 |
1,859 |
$140K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
2,719 |
2,664 |
$131K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
20,132 |
15,318 |
$126K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,029 |
3,905 |
$119K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,461 |
2,417 |
$114K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
797 |
778 |
$94K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
11,709 |
11,345 |
$89K |
| E0776 |
Iv pole |
8,904 |
8,680 |
$89K |
| 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 |
2,070 |
2,010 |
$88K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
506 |
501 |
$72K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
465 |
457 |
$68K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
528 |
510 |
$60K |
| A7525 |
Tracheostomy mask, each |
5,675 |
4,370 |
$56K |
| A4605 |
Tracheal suction catheter, closed system, each |
3,295 |
3,222 |
$53K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
75 |
74 |
$49K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
210 |
193 |
$37K |
| A4244 |
Alcohol or peroxide, per pint |
10,504 |
10,175 |
$36K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
425 |
409 |
$36K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
487 |
188 |
$31K |
| A7015 |
Aerosol mask, used with dme nebulizer |
5,654 |
5,550 |
$22K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,716 |
2,642 |
$20K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,490 |
1,824 |
$19K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
101 |
101 |
$16K |
| A4332 |
Lubricant, individual sterile packet, each |
6,790 |
6,645 |
$16K |
| A4245 |
Alcohol wipes, per box |
6,092 |
5,957 |
$11K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,163 |
2,089 |
$6K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
439 |
397 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
74 |
74 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
354 |
340 |
$4K |
| L8501 |
Tracheostomy speaking valve |
24 |
24 |
$3K |
| A6210 |
Foam 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 |
14 |
13 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
142 |
140 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
12 |
12 |
$718.20 |
| E1392 |
Portable oxygen concentrator, rental |
12 |
12 |
$253.99 |
| A4930 |
Gloves, sterile, per pair |
38 |
37 |
$132.60 |