| 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 |
12,438 |
11,757 |
$523K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,231 |
6,899 |
$214K |
| 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 |
5,415 |
5,096 |
$180K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,713 |
1,630 |
$119K |
| E0570 |
Nebulizer, with compressor |
4,595 |
4,443 |
$103K |
| 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) |
1,105 |
1,054 |
$80K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,863 |
1,797 |
$63K |
| A7037 |
Tubing used with positive airway pressure device |
3,455 |
3,298 |
$56K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,020 |
971 |
$53K |
| A7035 |
Headgear used with positive airway pressure device |
2,844 |
2,735 |
$51K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
488 |
426 |
$49K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,546 |
1,474 |
$42K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
971 |
908 |
$31K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,587 |
5,328 |
$28K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,315 |
1,150 |
$25K |
| K0001 |
Standard wheelchair |
1,815 |
1,536 |
$25K |
| K0007 |
Extra heavy duty wheelchair |
634 |
478 |
$24K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
136 |
133 |
$24K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,053 |
936 |
$20K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
504 |
485 |
$19K |
| 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 |
105 |
90 |
$12K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,608 |
1,523 |
$10K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
56 |
48 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
331 |
318 |
$6K |
| A4565 |
Slings |
588 |
539 |
$5K |
| K0003 |
Lightweight wheelchair |
277 |
209 |
$5K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
42 |
41 |
$4K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
100 |
55 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
84 |
82 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
38 |
37 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
787 |
774 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
114 |
108 |
$930.69 |
| K0002 |
Standard hemi (low seat) wheelchair |
27 |
24 |
$740.06 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
19 |
12 |
$166.28 |