| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,498 |
3,139 |
$243K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,288 |
6,485 |
$140K |
| 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 |
3,667 |
3,280 |
$136K |
| 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 |
2,053 |
1,833 |
$81K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,099 |
2,845 |
$39K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,989 |
1,802 |
$21K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
3,996 |
3,765 |
$13K |
| E0776 |
Iv pole |
7,248 |
6,978 |
$8K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
936 |
849 |
$4K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
281 |
247 |
$951.24 |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
61 |
60 |
$932.31 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
93 |
86 |
$851.01 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
25 |
25 |
$340.08 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
102 |
100 |
$222.63 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
134 |
125 |
$100.16 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
39 |
39 |
$78.69 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
212 |
211 |
$71.40 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
70 |
68 |
$68.68 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
14 |
14 |
$10.24 |