| 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 |
3,434 |
3,056 |
$2.99M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
10,147 |
8,715 |
$2.25M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,800 |
2,033 |
$2.22M |
| E0601 |
Continuous positive airway pressure (cpap) device |
30,408 |
29,283 |
$1.45M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
21,233 |
19,757 |
$1.34M |
| 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 |
2,722 |
2,407 |
$650K |
| A7030 |
Full face mask used with positive airway pressure device, each |
8,187 |
7,858 |
$625K |
| 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 |
1,108 |
958 |
$543K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,164 |
5,815 |
$417K |
| A4554 |
Disposable underpads, all sizes |
3,753 |
3,547 |
$397K |
| B9998 |
Noc for enteral supplies |
5,956 |
4,168 |
$344K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,740 |
13,134 |
$238K |
| 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 |
1,860 |
1,634 |
$236K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,274 |
6,000 |
$212K |
| A4217 |
Sterile water/saline, 500 ml |
2,819 |
2,490 |
$205K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,398 |
2,141 |
$199K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,223 |
2,083 |
$192K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,862 |
2,631 |
$181K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,300 |
2,051 |
$178K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,746 |
1,479 |
$175K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,852 |
3,619 |
$165K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
228 |
212 |
$158K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,775 |
1,645 |
$150K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
2,107 |
1,874 |
$142K |
| A7035 |
Headgear used with positive airway pressure device |
12,007 |
11,491 |
$135K |
| 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) |
1,903 |
1,741 |
$134K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,787 |
1,678 |
$129K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,420 |
5,132 |
$125K |
| 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 |
984 |
908 |
$122K |
| 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 |
752 |
679 |
$105K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,891 |
2,741 |
$101K |
| A7037 |
Tubing used with positive airway pressure device |
9,079 |
8,728 |
$95K |
| E0570 |
Nebulizer, with compressor |
2,252 |
2,076 |
$93K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,951 |
4,635 |
$92K |
| A4605 |
Tracheal suction catheter, closed system, each |
820 |
750 |
$85K |
| E1399 |
Durable medical equipment, miscellaneous |
8,320 |
3,883 |
$78K |
| A4927 |
Gloves, non-sterile, per 100 |
5,049 |
4,660 |
$73K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
816 |
784 |
$72K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,410 |
1,334 |
$67K |
| E1392 |
Portable oxygen concentrator, rental |
9,478 |
8,862 |
$65K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,850 |
3,530 |
$62K |
| 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 |
231 |
218 |
$62K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
752 |
695 |
$60K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,406 |
9,920 |
$50K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
432 |
424 |
$48K |
| 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 |
165 |
158 |
$47K |
| A7002 |
Tubing, used with suction pump, each |
5,243 |
4,937 |
$43K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
346 |
327 |
$38K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
686 |
616 |
$37K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
919 |
867 |
$36K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,638 |
5,372 |
$33K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,470 |
1,352 |
$29K |
| A4623 |
Tracheostomy, inner cannula |
457 |
396 |
$27K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,991 |
1,827 |
$26K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
174 |
154 |
$26K |
| K0001 |
Standard wheelchair |
1,323 |
1,239 |
$23K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
891 |
839 |
$20K |
| A4618 |
Breathing circuits |
766 |
665 |
$15K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,229 |
4,953 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
245 |
227 |
$10K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
977 |
916 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
133 |
120 |
$8K |
| K0003 |
Lightweight wheelchair |
165 |
161 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,159 |
1,000 |
$7K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
552 |
512 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
337 |
319 |
$6K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,276 |
726 |
$5K |
| E0776 |
Iv pole |
397 |
360 |
$5K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
984 |
855 |
$5K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
170 |
152 |
$5K |
| A7012 |
Water collection device, used with large volume nebulizer |
650 |
556 |
$3K |
| A7525 |
Tracheostomy mask, each |
1,645 |
1,486 |
$3K |
| A4402 |
Lubricant, per ounce |
626 |
601 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,111 |
2,920 |
$3K |
| A4649 |
Surgical supply; miscellaneous |
559 |
502 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
354 |
334 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
73 |
69 |
$2K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
17 |
12 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13 |
12 |
$938.13 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
13 |
12 |
$735.01 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
39 |
37 |
$602.79 |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
15 |
13 |
$553.02 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$68.77 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
28 |
26 |
$53.87 |