| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
104,799 |
100,361 |
$14.71M |
| 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 |
16,171 |
15,459 |
$11.58M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
31,324 |
28,021 |
$7.70M |
| 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 |
25,578 |
24,432 |
$6.48M |
| B9998 |
Noc for enteral supplies |
50,645 |
36,022 |
$4.57M |
| 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 |
7,261 |
6,742 |
$2.69M |
| 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 |
7,406 |
7,021 |
$2.47M |
| 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 |
1,676 |
1,609 |
$2.33M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
12,776 |
11,821 |
$1.35M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
10,975 |
10,090 |
$1.20M |
| B9002 |
Enteral nutrition infusion pump, any type |
1,839 |
1,773 |
$1.20M |
| 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 |
4,402 |
4,190 |
$1.15M |
| 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 |
3,562 |
3,431 |
$1.10M |
| A4554 |
Disposable underpads, all sizes |
37,384 |
34,753 |
$1.05M |
| 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 |
1,470 |
1,408 |
$1.02M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,428 |
1,209 |
$827K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
904 |
839 |
$751K |
| 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 |
3,487 |
3,350 |
$721K |
| A4322 |
Irrigation syringe, bulb or piston, each |
30,158 |
26,002 |
$691K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,444 |
5,848 |
$671K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,307 |
6,684 |
$667K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,303 |
2,997 |
$535K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,742 |
5,168 |
$470K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
4,735 |
4,423 |
$450K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,707 |
2,567 |
$450K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,244 |
2,988 |
$423K |
| A7000 |
Canister, disposable, used with suction pump, each |
10,471 |
8,828 |
$407K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
585 |
453 |
$404K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,137 |
3,915 |
$385K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,848 |
2,682 |
$382K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
3,946 |
3,525 |
$342K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
14,787 |
10,377 |
$315K |
| 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 |
471 |
346 |
$302K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,770 |
2,658 |
$291K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,121 |
2,929 |
$281K |
| A4335 |
Incontinence supply; miscellaneous |
52,053 |
48,106 |
$280K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
393 |
367 |
$258K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
21,889 |
19,933 |
$257K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,855 |
1,366 |
$253K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,364 |
2,093 |
$228K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,397 |
1,214 |
$228K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
56,073 |
27,907 |
$220K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
880 |
840 |
$188K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,738 |
1,580 |
$186K |
| A4927 |
Gloves, non-sterile, per 100 |
25,591 |
23,726 |
$174K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,120 |
1,029 |
$164K |
| A7002 |
Tubing, used with suction pump, each |
9,598 |
9,030 |
$144K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
674 |
632 |
$142K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,093 |
997 |
$120K |
| B4100 |
Food thickener, administered orally, per ounce |
2,621 |
2,538 |
$114K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,627 |
4,275 |
$110K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,746 |
5,198 |
$104K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,776 |
5,879 |
$102K |
| E0570 |
Nebulizer, with compressor |
1,068 |
1,013 |
$99K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
3,287 |
2,726 |
$96K |
| A4670 |
Automatic blood pressure monitor |
1,941 |
1,814 |
$95K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,099 |
963 |
$88K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
747 |
719 |
$87K |
| B4162 |
Enteral formula, for pediatrics, 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 |
94 |
77 |
$78K |
| E0776 |
Iv pole |
1,261 |
1,225 |
$78K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,025 |
810 |
$76K |
| A4217 |
Sterile water/saline, 500 ml |
2,201 |
1,854 |
$74K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
14,158 |
12,534 |
$70K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12,474 |
11,626 |
$70K |
| A4605 |
Tracheal suction catheter, closed system, each |
376 |
304 |
$69K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
993 |
587 |
$65K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
209 |
195 |
$64K |
| B4082 |
Nasogastric tubing without stylet |
1,129 |
1,025 |
$58K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
10,125 |
9,367 |
$58K |
| E0601 |
Continuous positive airway pressure (cpap) device |
781 |
755 |
$58K |
| B4081 |
Nasogastric tubing with stylet |
982 |
904 |
$57K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
336 |
324 |
$56K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
974 |
895 |
$55K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
670 |
639 |
$53K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,629 |
1,306 |
$52K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14,156 |
13,569 |
$47K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
408 |
362 |
$41K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,363 |
1,230 |
$40K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
447 |
411 |
$37K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,871 |
1,594 |
$36K |
| E1399 |
Durable medical equipment, miscellaneous |
88 |
70 |
$35K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,896 |
1,737 |
$32K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,166 |
910 |
$32K |
| A7030 |
Full face mask used with positive airway pressure device, each |
297 |
283 |
$23K |
| A7037 |
Tubing used with positive airway pressure device |
1,103 |
1,025 |
$22K |
| A4402 |
Lubricant, per ounce |
4,260 |
3,923 |
$22K |
| 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) |
117 |
113 |
$20K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
5,121 |
4,764 |
$17K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,300 |
1,041 |
$17K |
| A7015 |
Aerosol mask, used with dme nebulizer |
12,595 |
12,143 |
$15K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,453 |
1,268 |
$14K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
1,177 |
1,091 |
$9K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
670 |
630 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
267 |
249 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,753 |
1,575 |
$8K |
| A7031 |
Face mask interface, replacement for full face mask, each |
245 |
231 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
941 |
898 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
520 |
484 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,000 |
764 |
$6K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
145 |
133 |
$6K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
73 |
64 |
$4K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
106 |
81 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
27 |
24 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
186 |
178 |
$2K |
| A4245 |
Alcohol wipes, per box |
983 |
929 |
$1K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
129 |
113 |
$1K |
| A7525 |
Tracheostomy mask, each |
589 |
541 |
$901.07 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
55 |
51 |
$875.73 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
12 |
12 |
$820.99 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$589.46 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
219 |
208 |
$169.33 |
| A9270 |
Non-covered item or service |
1,706 |
1,552 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,057 |
1,492 |
$0.00 |