| 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 |
363,738 |
351,791 |
$15.46M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
7,334 |
6,851 |
$3.62M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
41,972 |
40,746 |
$2.75M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
11,502 |
10,903 |
$2.37M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
6,627 |
6,227 |
$2.34M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
18,696 |
16,727 |
$2.29M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
292,392 |
284,180 |
$2.28M |
| K0001 |
Standard wheelchair |
125,290 |
116,764 |
$1.92M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
53,595 |
51,575 |
$1.76M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
3,046 |
2,539 |
$1.62M |
| E0570 |
Nebulizer, with compressor |
45,431 |
44,267 |
$1.44M |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
43,840 |
39,150 |
$1.25M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
9,472 |
8,145 |
$1.22M |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
36,669 |
35,336 |
$1.13M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
2,381 |
2,035 |
$1.03M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
14,174 |
12,535 |
$791K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
25,878 |
25,293 |
$646K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
18,059 |
17,333 |
$604K |
| A7030 |
Full face mask used with positive airway pressure device, each |
23,805 |
22,621 |
$601K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
12,351 |
10,937 |
$600K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,093 |
9,803 |
$588K |
| K0003 |
Lightweight wheelchair |
23,345 |
22,049 |
$577K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
6,532 |
6,445 |
$565K |
| K0007 |
Extra heavy duty wheelchair |
10,530 |
9,833 |
$554K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
21,192 |
20,360 |
$552K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
7,367 |
6,465 |
$537K |
| A7526 |
Tracheostomy tube collar/holder, each |
12,816 |
9,588 |
$504K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,338 |
2,191 |
$502K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
4,856 |
4,253 |
$486K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
13,750 |
12,012 |
$461K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
14,965 |
13,733 |
$430K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
46,640 |
44,246 |
$428K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
6,049 |
5,262 |
$418K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
17,701 |
16,838 |
$408K |
| A7031 |
Face mask interface, replacement for full face mask, each |
25,511 |
23,727 |
$350K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
4,691 |
4,078 |
$339K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,507 |
12,972 |
$331K |
| A4649 |
Surgical supply; miscellaneous |
16,706 |
11,682 |
$328K |
| E0277 |
Powered pressure-reducing air mattress |
4,097 |
3,411 |
$327K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
7,287 |
6,491 |
$290K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
7,032 |
6,758 |
$282K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
4,891 |
4,202 |
$280K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
9,220 |
8,697 |
$280K |
| A4217 |
Sterile water/saline, 500 ml |
4,796 |
4,275 |
$269K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,209 |
5,920 |
$266K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,565 |
2,264 |
$262K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
7,187 |
6,896 |
$249K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
5,733 |
4,923 |
$244K |
| 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 |
3,476 |
3,039 |
$243K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14,415 |
13,712 |
$239K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
4,056 |
3,587 |
$221K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
20,093 |
15,842 |
$213K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
3,381 |
3,057 |
$212K |
| A4623 |
Tracheostomy, inner cannula |
3,443 |
2,887 |
$205K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
27,237 |
26,402 |
$199K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
3,876 |
3,783 |
$198K |
| A4670 |
Automatic blood pressure monitor |
4,764 |
4,700 |
$183K |
| A6252 |
Specialty absorptive 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 |
4,960 |
4,305 |
$176K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
16,202 |
14,531 |
$173K |
| 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 |
10,206 |
8,582 |
$171K |
| 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) |
5,781 |
5,567 |
$170K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
3,219 |
2,917 |
$169K |
| E0245 |
Tub stool or bench |
3,362 |
3,300 |
$168K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
25,187 |
24,274 |
$159K |
| 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 |
538 |
471 |
$159K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
4,328 |
4,286 |
$157K |
| 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 |
19,944 |
15,412 |
$157K |
| E0619 |
Apnea monitor, with recording feature |
1,487 |
1,378 |
$156K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,683 |
1,505 |
$152K |
| E1392 |
Portable oxygen concentrator, rental |
14,264 |
13,795 |
$150K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,086 |
2,038 |
$148K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
5,454 |
4,685 |
$145K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,288 |
1,147 |
$137K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,835 |
2,638 |
$135K |
| 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) |
10,797 |
10,522 |
$124K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
16,897 |
13,338 |
$123K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
6,734 |
5,851 |
$122K |
| E0635 |
Patient lift, electric with seat or sling |
2,457 |
2,188 |
$121K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,551 |
2,127 |
$119K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,931 |
2,810 |
$116K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
1,247 |
1,096 |
$114K |
| E0601 |
Continuous positive airway pressure (cpap) device |
34,456 |
33,684 |
$113K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,670 |
2,537 |
$112K |
| A7037 |
Tubing used with positive airway pressure device |
30,684 |
28,834 |
$111K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
76,098 |
68,712 |
$109K |
| A7035 |
Headgear used with positive airway pressure device |
23,140 |
22,128 |
$108K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12,148 |
10,907 |
$106K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,155 |
1,025 |
$105K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,710 |
3,627 |
$104K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
578 |
505 |
$103K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
3,613 |
3,501 |
$92K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,428 |
7,252 |
$91K |
| K0006 |
Heavy duty wheelchair |
2,322 |
2,188 |
$90K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
5,801 |
5,621 |
$83K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,252 |
2,047 |
$81K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,660 |
1,409 |
$80K |
| A7000 |
Canister, disposable, used with suction pump, each |
12,827 |
11,269 |
$79K |
| A4452 |
Tape, waterproof, per 18 square inches |
9,120 |
7,765 |
$76K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
2,014 |
1,819 |
$75K |
| E0156 |
Seat attachment, walker |
9,595 |
9,287 |
$75K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,902 |
2,821 |
$71K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14,304 |
12,243 |
$69K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
3,837 |
2,992 |
$69K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
12,718 |
12,194 |
$69K |
| A5120 |
Skin barrier, wipes or swabs, each |
14,650 |
12,719 |
$68K |
| 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 |
5,688 |
4,701 |
$65K |
| A7002 |
Tubing, used with suction pump, each |
14,615 |
11,630 |
$65K |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
1,822 |
1,703 |
$63K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
411 |
383 |
$60K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
8,103 |
7,140 |
$59K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
8,963 |
6,883 |
$59K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
929 |
852 |
$58K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
8,221 |
6,888 |
$58K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
18,993 |
18,010 |
$57K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
2,358 |
1,945 |
$56K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
7,320 |
6,457 |
$54K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
992 |
847 |
$53K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13,488 |
11,711 |
$52K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
1,704 |
1,462 |
$50K |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,064 |
994 |
$50K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,633 |
1,435 |
$46K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
3,904 |
3,400 |
$46K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
8,134 |
6,143 |
$43K |
| E0244 |
Raised toilet seat |
1,771 |
1,725 |
$43K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,581 |
2,507 |
$42K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,243 |
1,863 |
$42K |
| B9002 |
Enteral nutrition infusion pump, any type |
7,739 |
7,409 |
$39K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
2,383 |
2,115 |
$38K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,798 |
4,765 |
$38K |
| A4618 |
Breathing circuits |
2,620 |
2,457 |
$37K |
| A4927 |
Gloves, non-sterile, per 100 |
4,233 |
3,236 |
$35K |
| 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 |
4,499 |
3,763 |
$35K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
8,034 |
7,102 |
$34K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
1,451 |
1,413 |
$34K |
| E1399 |
Durable medical equipment, miscellaneous |
1,714 |
1,546 |
$32K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
5,313 |
4,725 |
$30K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
1,794 |
1,375 |
$30K |
| A4402 |
Lubricant, per ounce |
6,983 |
5,962 |
$30K |
| E0274 |
Over-bed table |
1,398 |
1,259 |
$30K |
| 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 |
1,049 |
883 |
$27K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
764 |
716 |
$27K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
15,067 |
14,257 |
$26K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
7,692 |
5,833 |
$25K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
264 |
221 |
$24K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,204 |
1,073 |
$24K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,021 |
960 |
$23K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,991 |
5,613 |
$22K |
| 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 |
1,052 |
974 |
$22K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,613 |
1,583 |
$21K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
828 |
812 |
$20K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
330 |
258 |
$18K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,587 |
6,825 |
$18K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
1,264 |
1,122 |
$17K |
| 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 |
4,298 |
2,812 |
$17K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
3,568 |
2,123 |
$17K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
523 |
508 |
$16K |
| A4371 |
Ostomy skin barrier, powder, per oz |
6,582 |
6,019 |
$15K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
424 |
396 |
$15K |
| A4332 |
Lubricant, individual sterile packet, each |
2,184 |
1,938 |
$15K |
| 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 |
2,172 |
1,924 |
$13K |
| E0705 |
Transfer device, any type, each |
400 |
389 |
$13K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
4,572 |
4,331 |
$13K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
151 |
144 |
$12K |
| A4367 |
Ostomy belt, each |
3,269 |
2,938 |
$12K |
| A7525 |
Tracheostomy mask, each |
5,968 |
5,168 |
$11K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
343 |
307 |
$11K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
155 |
151 |
$11K |
| E0776 |
Iv pole |
747 |
724 |
$11K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
546 |
539 |
$11K |
| A7012 |
Water collection device, used with large volume nebulizer |
4,807 |
4,144 |
$10K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
122 |
111 |
$10K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,741 |
1,718 |
$10K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
788 |
746 |
$10K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
163 |
149 |
$10K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
524 |
518 |
$9K |
| L8501 |
Tracheostomy speaking valve |
202 |
192 |
$9K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
209 |
138 |
$9K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
870 |
837 |
$8K |
| K0002 |
Standard hemi (low seat) wheelchair |
319 |
305 |
$8K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
341 |
339 |
$8K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
1,837 |
1,667 |
$8K |
| E0153 |
Platform attachment, forearm crutch, each |
180 |
179 |
$8K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
765 |
696 |
$8K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
233 |
198 |
$7K |
| A7015 |
Aerosol mask, used with dme nebulizer |
11,472 |
11,221 |
$7K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
546 |
411 |
$7K |
| E0940 |
Trapeze bar, free standing, complete with grab bar |
577 |
527 |
$6K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
119 |
104 |
$6K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
1,118 |
987 |
$6K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
657 |
609 |
$6K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
226 |
213 |
$5K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
2,957 |
2,409 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,135 |
5,249 |
$5K |
| E0241 |
Bath tub wall rail, each |
269 |
261 |
$5K |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
1,421 |
1,286 |
$5K |
| A4384 |
Ostomy faceplate equivalent, silicone ring, each |
62 |
41 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
233 |
208 |
$4K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,651 |
1,459 |
$4K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
140 |
116 |
$4K |
| E1372 |
Immersion external heater for nebulizer |
442 |
427 |
$4K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,246 |
1,535 |
$4K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
51 |
36 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
563 |
513 |
$4K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
765 |
559 |
$3K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
2,038 |
1,782 |
$3K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,131 |
1,000 |
$3K |
| B4100 |
Food thickener, administered orally, per ounce |
1,194 |
1,112 |
$3K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
59 |
54 |
$3K |
| 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 |
3,507 |
2,987 |
$3K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,656 |
1,492 |
$2K |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
691 |
682 |
$2K |
| B9998 |
Noc for enteral supplies |
342 |
297 |
$1K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
659 |
659 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
729 |
638 |
$1K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
43 |
42 |
$1K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
56 |
45 |
$1K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
81 |
57 |
$1K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
77 |
69 |
$1K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
14 |
13 |
$993.70 |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
66 |
60 |
$928.05 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
161 |
158 |
$810.32 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
298 |
293 |
$710.91 |
| A4615 |
Cannula, nasal |
441 |
286 |
$695.87 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
384 |
198 |
$676.03 |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
14 |
13 |
$645.49 |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
15 |
15 |
$545.94 |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
40 |
29 |
$541.84 |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
26 |
24 |
$528.47 |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
53 |
49 |
$482.84 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
88 |
84 |
$479.83 |
| A4616 |
Tubing (oxygen), per foot |
180 |
170 |
$400.64 |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
28 |
25 |
$370.03 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
171 |
116 |
$362.11 |
| B4104 |
Additive for enteral formula (e.g., fiber) |
1,857 |
1,620 |
$356.52 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
12 |
12 |
$299.99 |
| E0911 |
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar |
12 |
12 |
$236.06 |
| A6260 |
Wound cleansers, any type, any size |
16 |
15 |
$170.70 |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
15 |
13 |
$152.04 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
61 |
56 |
$127.46 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
18 |
15 |
$92.60 |
| A7036 |
Chinstrap used with positive airway pressure device |
147 |
136 |
$90.33 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
72 |
71 |
$26.27 |
| A4456 |
Adhesive remover, wipes, any type, each |
81 |
65 |
$19.76 |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
13 |
$0.00 |