| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,594 |
1,077 |
$953K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,125 |
2,627 |
$625K |
| 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 |
896 |
798 |
$544K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,564 |
3,402 |
$346K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,457 |
2,601 |
$283K |
| 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 |
1,291 |
1,101 |
$278K |
| B9998 |
Noc for enteral supplies |
4,631 |
3,189 |
$271K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,426 |
1,352 |
$175K |
| E1399 |
Durable medical equipment, miscellaneous |
269 |
174 |
$160K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
615 |
603 |
$143K |
| A4605 |
Tracheal suction catheter, closed system, each |
990 |
764 |
$139K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,568 |
1,310 |
$110K |
| K0001 |
Standard wheelchair |
2,331 |
2,267 |
$105K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
812 |
783 |
$95K |
| 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 |
325 |
316 |
$93K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,658 |
2,355 |
$85K |
| 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 |
350 |
291 |
$73K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
374 |
363 |
$66K |
| B9002 |
Enteral nutrition infusion pump, any type |
763 |
744 |
$65K |
| 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 |
416 |
401 |
$62K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,985 |
1,611 |
$61K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
491 |
427 |
$60K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,453 |
3,314 |
$60K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
786 |
713 |
$57K |
| A4554 |
Disposable underpads, all sizes |
1,472 |
1,407 |
$50K |
| A7002 |
Tubing, used with suction pump, each |
2,514 |
2,426 |
$37K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,996 |
2,919 |
$33K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
40 |
37 |
$25K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
7,089 |
2,903 |
$21K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
161 |
139 |
$21K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,940 |
1,619 |
$20K |
| E0601 |
Continuous positive airway pressure (cpap) device |
488 |
478 |
$18K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,682 |
2,555 |
$17K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
97 |
94 |
$14K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
231 |
221 |
$12K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
439 |
422 |
$11K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
446 |
428 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,070 |
1,883 |
$11K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,358 |
2,269 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
1,719 |
1,639 |
$9K |
| A4481 |
Tracheostoma filter, any type, any size, each |
989 |
827 |
$8K |
| A4335 |
Incontinence supply; miscellaneous |
1,747 |
1,641 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,315 |
2,223 |
$6K |
| A4402 |
Lubricant, per ounce |
1,521 |
1,461 |
$6K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
86 |
85 |
$5K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
37 |
36 |
$5K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
28 |
25 |
$2K |
| A7525 |
Tracheostomy mask, each |
882 |
758 |
$2K |
| A4245 |
Alcohol wipes, per box |
695 |
677 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
16 |
16 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
584 |
568 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
643 |
632 |
$641.85 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
177 |
169 |
$483.51 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
690 |
663 |
$417.65 |
| A4244 |
Alcohol or peroxide, per pint |
552 |
531 |
$321.49 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
14 |
$56.95 |