| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
391 |
217 |
$264K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,620 |
1,471 |
$160K |
| 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 |
329 |
299 |
$146K |
| 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 |
1,057 |
931 |
$136K |
| 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 |
1,151 |
1,001 |
$115K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,079 |
604 |
$109K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
707 |
372 |
$97K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
107 |
106 |
$36K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
165 |
146 |
$36K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,567 |
910 |
$17K |
| A4217 |
Sterile water/saline, 500 ml |
316 |
247 |
$16K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
252 |
145 |
$10K |
| A7526 |
Tracheostomy tube collar/holder, each |
224 |
190 |
$7K |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
40 |
34 |
$3K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
28 |
24 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
232 |
215 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
100 |
56 |
$2K |
| J7606 |
Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms |
15 |
13 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
185 |
174 |
$2K |
| J7605 |
Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms |
21 |
17 |
$2K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
97 |
74 |
$2K |
| E0570 |
Nebulizer, with compressor |
171 |
138 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
16 |
15 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
161 |
85 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
228 |
211 |
$1K |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
133 |
85 |
$542.70 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
163 |
85 |
$522.90 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
294 |
275 |
$444.76 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
52 |
40 |
$225.64 |
| A7525 |
Tracheostomy mask, each |
136 |
73 |
$114.57 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
44 |
37 |
$95.15 |