| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
6,566 |
6,363 |
$970K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,377 |
12,783 |
$594K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
3,961 |
3,826 |
$517K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
7,766 |
7,508 |
$405K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
17,837 |
17,269 |
$363K |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
9,712 |
9,269 |
$357K |
| K0003 |
Lightweight wheelchair |
6,285 |
5,482 |
$218K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,218 |
2,725 |
$190K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
4,352 |
4,158 |
$185K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
3,889 |
3,690 |
$143K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,952 |
2,569 |
$106K |
| E0570 |
Nebulizer, with compressor |
6,358 |
5,849 |
$105K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,697 |
5,910 |
$103K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,419 |
2,244 |
$77K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
907 |
875 |
$68K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,738 |
1,478 |
$48K |
| E1392 |
Portable oxygen concentrator, rental |
3,208 |
2,745 |
$42K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
4,246 |
3,741 |
$39K |
| K0001 |
Standard wheelchair |
1,812 |
1,612 |
$36K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
586 |
488 |
$24K |
| K0007 |
Extra heavy duty wheelchair |
285 |
237 |
$22K |
| 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) |
210 |
171 |
$19K |
| A7030 |
Full face mask used with positive airway pressure device, each |
409 |
353 |
$19K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
596 |
549 |
$14K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
996 |
900 |
$13K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
467 |
374 |
$13K |
| 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 |
886 |
775 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
833 |
710 |
$12K |
| T4541 |
Incontinence product, disposable underpad, large, each |
360 |
318 |
$12K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
387 |
363 |
$12K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,292 |
1,136 |
$12K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
269 |
242 |
$11K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
1,034 |
970 |
$10K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
82 |
78 |
$10K |
| A7037 |
Tubing used with positive airway pressure device |
947 |
822 |
$10K |
| K0006 |
Heavy duty wheelchair |
127 |
108 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
108 |
102 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,878 |
2,513 |
$8K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
231 |
220 |
$8K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
41 |
39 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
215 |
188 |
$6K |
| A4570 |
Splint |
816 |
755 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
400 |
359 |
$6K |
| L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
41 |
39 |
$5K |
| A7031 |
Face mask interface, replacement for full face mask, each |
172 |
144 |
$5K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
69 |
63 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
168 |
135 |
$5K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
12 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,449 |
1,165 |
$4K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
701 |
649 |
$4K |
| 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 |
66 |
47 |
$4K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
678 |
566 |
$4K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
53 |
49 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
34 |
32 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
14 |
14 |
$2K |
| E0627 |
Seat lift mechanism, electric, any type |
36 |
27 |
$2K |
| 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 |
22 |
16 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,325 |
1,164 |
$2K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
33 |
31 |
$2K |
| 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 |
20 |
16 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
63 |
53 |
$1K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
142 |
135 |
$784.09 |
| A7015 |
Aerosol mask, used with dme nebulizer |
460 |
362 |
$778.78 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
20 |
12 |
$711.96 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
93 |
92 |
$678.20 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
15 |
12 |
$664.31 |
| L0120 |
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
25 |
25 |
$363.47 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
55 |
51 |
$293.54 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
116 |
94 |
$263.67 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
28 |
24 |
$258.52 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
25 |
15 |
$1.14 |