| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,537 |
8,390 |
$637K |
| 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 |
4,084 |
4,024 |
$382K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,053 |
6,013 |
$285K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,772 |
2,756 |
$102K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,721 |
5,680 |
$94K |
| E0570 |
Nebulizer, with compressor |
3,070 |
3,046 |
$93K |
| K0003 |
Lightweight wheelchair |
2,098 |
2,092 |
$70K |
| 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) |
548 |
546 |
$48K |
| A7030 |
Full face mask used with positive airway pressure device, each |
690 |
681 |
$42K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
242 |
242 |
$41K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
366 |
359 |
$32K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
538 |
491 |
$27K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
175 |
140 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
1,131 |
1,113 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
897 |
884 |
$18K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
397 |
396 |
$18K |
| A4670 |
Automatic blood pressure monitor |
344 |
344 |
$17K |
| K0001 |
Standard wheelchair |
1,500 |
1,494 |
$16K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
68 |
63 |
$16K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
542 |
538 |
$15K |
| 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 |
139 |
129 |
$15K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
853 |
844 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,503 |
1,442 |
$11K |
| 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) |
39 |
39 |
$10K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
226 |
224 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
163 |
153 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
802 |
779 |
$4K |
| E0156 |
Seat attachment, walker |
304 |
303 |
$3K |
| K0004 |
High strength, lightweight wheelchair |
28 |
27 |
$3K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
78 |
52 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
38 |
37 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
173 |
170 |
$948.18 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
24 |
24 |
$943.02 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
664 |
649 |
$672.81 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
14 |
13 |
$635.73 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
39 |
26 |
$611.00 |
| E0776 |
Iv pole |
37 |
37 |
$229.31 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
13 |
13 |
$193.71 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
14 |
13 |
$132.36 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
161 |
159 |
$78.05 |
| E0245 |
Tub stool or bench |
12 |
12 |
$67.00 |
| A4259 |
Lancets, per box of 100 |
12 |
12 |
$29.56 |
| A7015 |
Aerosol mask, used with dme nebulizer |
26 |
26 |
$27.97 |