| 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 |
18,926 |
18,578 |
$1.73M |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,240 |
8,157 |
$487K |
| E0570 |
Nebulizer, with compressor |
5,889 |
5,853 |
$275K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,782 |
1,531 |
$256K |
| 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) |
1,959 |
1,933 |
$238K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,716 |
1,712 |
$232K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,629 |
9,214 |
$218K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,163 |
2,148 |
$141K |
| K0003 |
Lightweight wheelchair |
3,094 |
3,066 |
$113K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
9,137 |
9,041 |
$107K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,311 |
1,303 |
$70K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,303 |
1,289 |
$69K |
| 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 |
691 |
625 |
$64K |
| 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 |
412 |
351 |
$61K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,509 |
1,130 |
$60K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,999 |
1,917 |
$50K |
| A7035 |
Headgear used with positive airway pressure device |
2,509 |
2,485 |
$47K |
| A7037 |
Tubing used with positive airway pressure device |
2,814 |
2,793 |
$47K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
1,324 |
1,306 |
$46K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,171 |
2,159 |
$39K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
880 |
790 |
$37K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
757 |
752 |
$33K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
514 |
476 |
$29K |
| E1392 |
Portable oxygen concentrator, rental |
3,283 |
3,274 |
$22K |
| 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 |
153 |
129 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,346 |
3,096 |
$19K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
71 |
68 |
$13K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
467 |
458 |
$11K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
740 |
720 |
$11K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
102 |
91 |
$11K |
| A4670 |
Automatic blood pressure monitor |
160 |
160 |
$10K |
| 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 |
964 |
961 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
342 |
337 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
916 |
904 |
$5K |
| A4259 |
Lancets, per box of 100 |
1,236 |
1,218 |
$4K |
| A7000 |
Canister, disposable, used with suction pump, each |
392 |
383 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
54 |
48 |
$4K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
434 |
425 |
$4K |
| K0004 |
High strength, lightweight wheelchair |
62 |
62 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
185 |
167 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,623 |
1,600 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
952 |
931 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
72 |
71 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
42 |
36 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
81 |
80 |
$2K |
| E0156 |
Seat attachment, walker |
200 |
199 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13 |
12 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
217 |
212 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
12 |
12 |
$1K |
| E0607 |
Home blood glucose monitor |
28 |
28 |
$783.43 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
26 |
26 |
$704.32 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15 |
12 |
$661.64 |
| E0776 |
Iv pole |
53 |
51 |
$434.12 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
12 |
12 |
$412.88 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
79 |
53 |
$138.34 |
| E0184 |
Dry pressure mattress |
64 |
64 |
$83.58 |