| 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 |
64,452 |
62,383 |
$6.96M |
| E0601 |
Continuous positive airway pressure (cpap) device |
110,001 |
106,735 |
$4.97M |
| K0001 |
Standard wheelchair |
86,672 |
84,183 |
$2.08M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13,665 |
12,677 |
$2.03M |
| B9002 |
Enteral nutrition infusion pump, any type |
26,340 |
25,637 |
$1.58M |
| 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) |
13,593 |
13,209 |
$1.47M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
127,918 |
124,450 |
$1.25M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
17,031 |
16,544 |
$1.18M |
| E0570 |
Nebulizer, with compressor |
19,024 |
18,134 |
$1.16M |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
6,607 |
6,482 |
$857K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
50,518 |
48,589 |
$745K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,260 |
1,139 |
$675K |
| 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 |
2,260 |
1,889 |
$661K |
| E0619 |
Apnea monitor, with recording feature |
7,426 |
6,461 |
$611K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
2,472 |
2,407 |
$551K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
8,559 |
8,251 |
$545K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,716 |
2,371 |
$394K |
| K0007 |
Extra heavy duty wheelchair |
4,900 |
4,755 |
$376K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
7,302 |
7,033 |
$351K |
| 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 |
1,863 |
1,597 |
$343K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
5,891 |
5,690 |
$334K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
12,597 |
12,070 |
$310K |
| K0003 |
Lightweight wheelchair |
8,315 |
8,125 |
$301K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
4,164 |
4,084 |
$253K |
| K0006 |
Heavy duty wheelchair |
4,767 |
4,642 |
$244K |
| K0813 |
Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds |
1,271 |
1,248 |
$223K |
| 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 |
1,309 |
1,061 |
$212K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
5,509 |
5,349 |
$209K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
1,434 |
1,395 |
$205K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,448 |
1,286 |
$198K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
38,335 |
37,411 |
$181K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,774 |
3,540 |
$176K |
| A4927 |
Gloves, non-sterile, per 100 |
7,031 |
5,249 |
$154K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,596 |
3,472 |
$136K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,677 |
9,339 |
$129K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,106 |
1,033 |
$109K |
| A7002 |
Tubing, used with suction pump, each |
6,916 |
3,988 |
$102K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,062 |
1,911 |
$96K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
2,196 |
1,801 |
$86K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,535 |
1,343 |
$83K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
747 |
659 |
$74K |
| E0776 |
Iv pole |
26,746 |
25,908 |
$71K |
| A4245 |
Alcohol wipes, per box |
866 |
788 |
$68K |
| A4217 |
Sterile water/saline, 500 ml |
4,364 |
3,818 |
$64K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
5,936 |
4,336 |
$63K |
| K0801 |
Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds |
578 |
576 |
$60K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
345 |
293 |
$57K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
372 |
364 |
$56K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
4,034 |
3,872 |
$55K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,165 |
2,726 |
$52K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
23,226 |
22,201 |
$49K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,881 |
3,625 |
$49K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,319 |
1,099 |
$36K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
6,665 |
5,974 |
$35K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
535 |
476 |
$34K |
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
127 |
121 |
$31K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
107 |
100 |
$30K |
| A4332 |
Lubricant, individual sterile packet, each |
957 |
866 |
$29K |
| A4618 |
Breathing circuits |
1,604 |
1,371 |
$29K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
372 |
336 |
$27K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
324 |
318 |
$27K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
3,297 |
3,212 |
$26K |
| E0156 |
Seat attachment, walker |
3,570 |
3,419 |
$25K |
| A4623 |
Tracheostomy, inner cannula |
427 |
359 |
$23K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,125 |
3,725 |
$22K |
| A6252 |
Specialty absorptive 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 |
763 |
694 |
$22K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,107 |
1,038 |
$22K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
533 |
517 |
$18K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,793 |
2,603 |
$14K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,198 |
1,945 |
$14K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
318 |
284 |
$13K |
| A4244 |
Alcohol or peroxide, per pint |
765 |
544 |
$13K |
| E0635 |
Patient lift, electric with seat or sling |
324 |
310 |
$13K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,218 |
1,175 |
$12K |
| A7525 |
Tracheostomy mask, each |
1,650 |
1,528 |
$12K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,677 |
3,292 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,061 |
980 |
$11K |
| E0245 |
Tub stool or bench |
1,106 |
954 |
$11K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,449 |
1,352 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
944 |
873 |
$11K |
| 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 |
157 |
126 |
$10K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,917 |
1,779 |
$9K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
359 |
333 |
$8K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
282 |
237 |
$8K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
918 |
861 |
$8K |
| B9998 |
Noc for enteral supplies |
76 |
65 |
$8K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
340 |
320 |
$8K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,563 |
1,467 |
$6K |
| A4452 |
Tape, waterproof, per 18 square inches |
982 |
886 |
$6K |
| A4605 |
Tracheal suction catheter, closed system, each |
271 |
245 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,055 |
983 |
$5K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
210 |
187 |
$5K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
383 |
362 |
$5K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
132 |
126 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
21,473 |
20,586 |
$5K |
| 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 |
64 |
52 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,550 |
5,883 |
$4K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
41 |
38 |
$4K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
149 |
124 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
97 |
93 |
$3K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
113 |
105 |
$3K |
| E0940 |
Trapeze bar, free standing, complete with grab bar |
153 |
150 |
$2K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
48 |
46 |
$1K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
322 |
296 |
$960.85 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
285 |
266 |
$801.28 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
215 |
194 |
$627.87 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
97 |
84 |
$448.36 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
135 |
113 |
$388.26 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
18 |
12 |
$306.08 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
16 |
13 |
$171.98 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$141.84 |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
312 |
283 |
$70.18 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
56 |
47 |
$32.61 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
24 |
24 |
$21.77 |
| A4367 |
Ostomy belt, each |
13 |
12 |
$0.00 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
58 |
52 |
$0.00 |