| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,006 |
8,732 |
$2.10M |
| 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 |
4,502 |
3,626 |
$2.01M |
| 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 |
13,575 |
11,087 |
$1.42M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
23,917 |
14,292 |
$786K |
| 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 |
5,089 |
3,727 |
$692K |
| 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 |
1,964 |
1,442 |
$691K |
| 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 |
3,526 |
2,708 |
$402K |
| 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 |
3,005 |
2,384 |
$372K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,314 |
3,252 |
$371K |
| 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 |
543 |
387 |
$236K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,879 |
1,501 |
$218K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,993 |
2,453 |
$211K |
| B9998 |
Noc for enteral supplies |
3,248 |
1,413 |
$177K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
899 |
737 |
$132K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,015 |
571 |
$98K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,035 |
8,603 |
$90K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
308 |
168 |
$80K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,526 |
2,260 |
$77K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,626 |
1,198 |
$68K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
609 |
355 |
$53K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,209 |
1,595 |
$48K |
| E0776 |
Iv pole |
1,905 |
1,486 |
$33K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,351 |
942 |
$30K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,438 |
2,307 |
$25K |
| A7037 |
Tubing used with positive airway pressure device |
2,163 |
1,578 |
$18K |
| E1392 |
Portable oxygen concentrator, rental |
2,397 |
1,387 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
2,021 |
1,474 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,054 |
3,783 |
$15K |
| 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 |
71 |
50 |
$14K |
| E0570 |
Nebulizer, with compressor |
4,284 |
2,840 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
621 |
444 |
$14K |
| B4100 |
Food thickener, administered orally, per ounce |
28 |
25 |
$5K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
447 |
321 |
$5K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
101 |
37 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
33 |
24 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
19 |
15 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
83 |
62 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
495 |
367 |
$1K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
175 |
99 |
$1K |
| A7526 |
Tracheostomy tube collar/holder, each |
56 |
40 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,376 |
1,141 |
$938.75 |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
16 |
14 |
$619.20 |
| A4217 |
Sterile water/saline, 500 ml |
16 |
14 |
$570.48 |
| A7000 |
Canister, disposable, used with suction pump, each |
50 |
40 |
$550.54 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
150 |
92 |
$309.71 |
| A7002 |
Tubing, used with suction pump, each |
71 |
55 |
$259.40 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
41 |
30 |
$121.67 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
16 |
14 |
$88.07 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
41 |
28 |
$56.19 |