| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
6,393 |
2,925 |
$3.04M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
99,556 |
6,597 |
$1.52M |
| 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 |
4,480 |
2,387 |
$1.13M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,434 |
878 |
$500K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,491 |
3,126 |
$449K |
| 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 |
2,335 |
920 |
$246K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
2,267 |
507 |
$187K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,539 |
1,216 |
$161K |
| 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 |
2,466 |
1,369 |
$161K |
| 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 |
648 |
321 |
$156K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,808 |
1,697 |
$108K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
524 |
470 |
$101K |
| 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 |
2,136 |
906 |
$88K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,925 |
2,215 |
$71K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,982 |
976 |
$59K |
| B4224 |
Parenteral nutrition administration kit, per day |
705 |
88 |
$59K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,983 |
1,485 |
$51K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
628 |
82 |
$47K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
712 |
371 |
$44K |
| A4217 |
Sterile water/saline, 500 ml |
265 |
107 |
$41K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,180 |
762 |
$32K |
| A7030 |
Full face mask used with positive airway pressure device, each |
447 |
272 |
$27K |
| A7526 |
Tracheostomy tube collar/holder, each |
287 |
196 |
$23K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
700 |
88 |
$19K |
| 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 |
501 |
340 |
$18K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
2,570 |
222 |
$16K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
214 |
103 |
$12K |
| 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) |
186 |
132 |
$11K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,124 |
703 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
528 |
368 |
$10K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
196 |
60 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,410 |
875 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
93 |
76 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
412 |
297 |
$6K |
| A7031 |
Face mask interface, replacement for full face mask, each |
183 |
94 |
$6K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
235 |
171 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
474 |
287 |
$4K |
| A7002 |
Tubing, used with suction pump, each |
873 |
563 |
$3K |
| T1030 |
Nursing care, in the home, by registered nurse, per diem |
37 |
24 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
238 |
167 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
67 |
51 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
179 |
72 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
182 |
118 |
$788.78 |
| A4605 |
Tracheal suction catheter, closed system, each |
17 |
13 |
$612.31 |
| E0570 |
Nebulizer, with compressor |
39 |
37 |
$340.68 |