| 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 |
13,610 |
3,862 |
$163K |
| 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 |
5,291 |
1,549 |
$105K |
| 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 |
2,344 |
579 |
$76K |
| 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 |
7,497 |
2,075 |
$73K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,551 |
1,426 |
$22K |
| A4322 |
Irrigation syringe, bulb or piston, each |
15,815 |
4,578 |
$20K |
| 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 |
368 |
340 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,317 |
2,167 |
$3K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,993 |
1,870 |
$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 |
166 |
53 |
$1K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,347 |
2,192 |
$1K |
| E0776 |
Iv pole |
1,865 |
1,776 |
$998.35 |
| 0013A |
|
12 |
12 |
$0.00 |
| 0003A |
|
86 |
86 |
$0.00 |