| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
8,926 |
8,346 |
$853K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
23,712 |
23,436 |
$590K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,590 |
7,177 |
$538K |
| T4541 |
Incontinence product, disposable underpad, large, each |
16,073 |
14,299 |
$531K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,087 |
6,740 |
$462K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,325 |
1,142 |
$460K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,388 |
5,063 |
$448K |
| K0001 |
Standard wheelchair |
27,326 |
27,022 |
$424K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,543 |
4,099 |
$361K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,083 |
7,629 |
$327K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,457 |
2,240 |
$327K |
| A4670 |
Automatic blood pressure monitor |
6,348 |
6,315 |
$321K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
11,666 |
11,466 |
$283K |
| 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 |
2,714 |
2,594 |
$261K |
| 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 |
4,059 |
3,453 |
$240K |
| A4927 |
Gloves, non-sterile, per 100 |
14,958 |
12,554 |
$237K |
| E0245 |
Tub stool or bench |
5,788 |
5,722 |
$217K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,943 |
2,754 |
$215K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,241 |
2,050 |
$207K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,855 |
1,785 |
$170K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
6,369 |
6,240 |
$164K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,474 |
1,181 |
$152K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
2,109 |
2,041 |
$142K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,094 |
1,060 |
$127K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
2,544 |
2,164 |
$112K |
| E0277 |
Powered pressure-reducing air mattress |
1,009 |
942 |
$110K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,327 |
3,266 |
$99K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
550 |
536 |
$93K |
| E0570 |
Nebulizer, with compressor |
9,084 |
8,831 |
$92K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
759 |
739 |
$83K |
| K0003 |
Lightweight wheelchair |
3,319 |
3,272 |
$79K |
| E0244 |
Raised toilet seat |
1,641 |
1,572 |
$77K |
| A6210 |
Foam 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 |
550 |
525 |
$73K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13,130 |
12,937 |
$71K |
| K0007 |
Extra heavy duty wheelchair |
1,385 |
1,357 |
$63K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,161 |
1,046 |
$58K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,030 |
2,730 |
$54K |
| 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 |
444 |
436 |
$51K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,766 |
4,864 |
$48K |
| A4335 |
Incontinence supply; miscellaneous |
6,296 |
3,557 |
$48K |
| 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 |
740 |
724 |
$46K |
| A6260 |
Wound cleansers, any type, any size |
2,963 |
2,649 |
$45K |
| E0156 |
Seat attachment, walker |
6,428 |
6,379 |
$41K |
| K0004 |
High strength, lightweight wheelchair |
1,590 |
1,579 |
$41K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,848 |
1,803 |
$40K |
| 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 |
406 |
326 |
$29K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,232 |
2,198 |
$27K |
| K0006 |
Heavy duty wheelchair |
751 |
720 |
$26K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
10,621 |
10,075 |
$26K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
4,131 |
4,092 |
$25K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
11,620 |
6,141 |
$22K |
| E0241 |
Bath tub wall rail, each |
750 |
722 |
$21K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,851 |
3,327 |
$20K |
| A4649 |
Surgical supply; miscellaneous |
1,638 |
732 |
$19K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
397 |
359 |
$18K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
2,023 |
2,013 |
$18K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
455 |
402 |
$18K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
362 |
322 |
$17K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
2,233 |
2,203 |
$17K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
100 |
98 |
$16K |
| E1399 |
Durable medical equipment, miscellaneous |
895 |
620 |
$16K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
2,797 |
2,715 |
$16K |
| 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 |
102 |
89 |
$15K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,314 |
2,084 |
$14K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
2,095 |
1,300 |
$14K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
476 |
436 |
$14K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
703 |
699 |
$13K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,478 |
1,135 |
$13K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
155 |
148 |
$13K |
| A4402 |
Lubricant, per ounce |
2,003 |
1,738 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
614 |
562 |
$10K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,834 |
1,448 |
$10K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
442 |
437 |
$9K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
1,075 |
1,052 |
$9K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
109 |
105 |
$8K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,087 |
915 |
$7K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
94 |
92 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,803 |
1,561 |
$6K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
14 |
12 |
$5K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
321 |
313 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
794 |
628 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
367 |
348 |
$4K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
158 |
136 |
$4K |
| B4100 |
Food thickener, administered orally, per ounce |
48 |
39 |
$4K |
| A4322 |
Irrigation syringe, bulb or piston, each |
202 |
171 |
$3K |
| E1031 |
Rollabout chair, any and all types with casters 5" or greater |
213 |
189 |
$3K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
34 |
34 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
380 |
319 |
$3K |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
1,305 |
1,267 |
$3K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
165 |
136 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
193 |
147 |
$2K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
527 |
445 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
26 |
26 |
$966.91 |
| E0184 |
Dry pressure mattress |
26 |
26 |
$965.78 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
73 |
67 |
$811.55 |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
29 |
25 |
$768.88 |
| A4245 |
Alcohol wipes, per box |
366 |
280 |
$722.36 |
| K0056 |
Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair |
70 |
70 |
$569.97 |
| A4663 |
Blood pressure cuff only |
16 |
16 |
$481.28 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
53 |
48 |
$434.97 |
| A4657 |
Syringe, with or without needle, each |
44 |
42 |
$419.80 |
| E0325 |
Urinal; male, jug-type, any material |
30 |
29 |
$340.06 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
274 |
267 |
$322.63 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
42 |
42 |
$161.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
77 |
76 |
$69.57 |
| 90662 |
|
88 |
88 |
$0.00 |
| 90674 |
|
43 |
43 |
$0.00 |
| 0134A |
|
34 |
34 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
141 |
141 |
$0.00 |
| 0064A |
|
31 |
31 |
$0.00 |