| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
2,497 |
1,791 |
$586K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,502 |
8,112 |
$551K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,387 |
4,113 |
$461K |
| E0601 |
Continuous positive airway pressure (cpap) device |
9,524 |
8,654 |
$414K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,748 |
3,098 |
$276K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
8,251 |
7,548 |
$174K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
431 |
340 |
$150K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,123 |
2,037 |
$150K |
| A7035 |
Headgear used with positive airway pressure device |
6,467 |
6,099 |
$150K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
874 |
811 |
$125K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,083 |
2,973 |
$84K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
159 |
154 |
$76K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
723 |
666 |
$75K |
| A7037 |
Tubing used with positive airway pressure device |
5,083 |
4,801 |
$71K |
| 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 |
532 |
469 |
$70K |
| 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) |
355 |
285 |
$58K |
| E0570 |
Nebulizer, with compressor |
4,311 |
4,000 |
$57K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
286 |
267 |
$50K |
| 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) |
1,113 |
1,027 |
$49K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,931 |
9,432 |
$47K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
4,975 |
4,658 |
$36K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,088 |
929 |
$35K |
| K0001 |
Standard wheelchair |
3,297 |
3,027 |
$30K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
808 |
771 |
$30K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
766 |
704 |
$26K |
| 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 |
3,501 |
3,360 |
$24K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
773 |
718 |
$21K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,580 |
2,475 |
$21K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
417 |
374 |
$17K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
191 |
183 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
690 |
656 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
309 |
225 |
$9K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
610 |
588 |
$9K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
61 |
53 |
$8K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
718 |
392 |
$8K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
141 |
139 |
$8K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
76 |
71 |
$7K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
1,013 |
997 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
88 |
78 |
$5K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
302 |
239 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
388 |
276 |
$4K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
204 |
171 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
433 |
378 |
$4K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
70 |
36 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,096 |
953 |
$3K |
| L3260 |
Surgical boot/shoe, each |
180 |
170 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
263 |
198 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
64 |
56 |
$2K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
53 |
52 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
34 |
28 |
$2K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
40 |
38 |
$2K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
30 |
25 |
$1K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
17 |
13 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
662 |
641 |
$1K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
44 |
37 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
645 |
618 |
$957.45 |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
16 |
14 |
$933.34 |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
41 |
36 |
$887.42 |
| A4456 |
Adhesive remover, wipes, any type, each |
219 |
199 |
$811.41 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
174 |
137 |
$713.12 |
| E0156 |
Seat attachment, walker |
88 |
82 |
$573.97 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
18 |
13 |
$553.20 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
13 |
12 |
$526.88 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
26 |
24 |
$347.93 |
| K0007 |
Extra heavy duty wheelchair |
12 |
12 |
$313.63 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
147 |
137 |
$158.53 |
| A4259 |
Lancets, per box of 100 |
13 |
12 |
$79.95 |
| A7015 |
Aerosol mask, used with dme nebulizer |
24 |
24 |
$22.38 |