| 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 |
15,745 |
14,772 |
$441K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,395 |
9,756 |
$65K |
| E1392 |
Portable oxygen concentrator, rental |
3,108 |
2,942 |
$49K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,184 |
1,108 |
$37K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,671 |
1,561 |
$32K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,350 |
1,224 |
$29K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,262 |
1,201 |
$29K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,283 |
4,016 |
$26K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,398 |
1,322 |
$24K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,085 |
1,024 |
$21K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
705 |
660 |
$15K |
| 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 |
412 |
349 |
$13K |
| A7037 |
Tubing used with positive airway pressure device |
1,989 |
1,870 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
1,452 |
1,356 |
$9K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
930 |
875 |
$8K |
| E0570 |
Nebulizer, with compressor |
3,040 |
2,924 |
$8K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
546 |
505 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
295 |
279 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
207 |
201 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
565 |
529 |
$277.64 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
117 |
112 |
$0.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
250 |
234 |
$0.00 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
62 |
60 |
$0.00 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
132 |
130 |
$0.00 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$0.00 |