| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
5,182 |
4,527 |
$151K |
| 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 |
2,658 |
2,345 |
$148K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,702 |
5,891 |
$103K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,050 |
3,520 |
$34K |
| E0776 |
Iv pole |
6,825 |
5,946 |
$32K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,421 |
2,036 |
$17K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
5,030 |
4,011 |
$15K |
| A4623 |
Tracheostomy, inner cannula |
310 |
284 |
$15K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,256 |
1,072 |
$13K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,743 |
1,486 |
$11K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
841 |
760 |
$8K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
5,404 |
4,317 |
$6K |
| A7526 |
Tracheostomy tube collar/holder, each |
818 |
738 |
$6K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
343 |
319 |
$5K |
| 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 |
116 |
106 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,459 |
4,374 |
$2K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
5,134 |
4,090 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
314 |
244 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,283 |
1,060 |
$1K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,275 |
1,056 |
$359.54 |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
120 |
85 |
$241.40 |