| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Continuous positive airway pressure (cpap) device |
19,234 |
17,783 |
$889K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
21,450 |
19,601 |
$337K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,854 |
3,550 |
$323K |
| 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) |
2,398 |
2,214 |
$309K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,981 |
4,726 |
$274K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,800 |
5,483 |
$264K |
| K0001 |
Standard wheelchair |
8,128 |
7,234 |
$217K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,159 |
4,860 |
$192K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
9,027 |
8,540 |
$174K |
| K0003 |
Lightweight wheelchair |
3,316 |
3,011 |
$163K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
1,680 |
1,460 |
$158K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,610 |
2,486 |
$138K |
| 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) |
676 |
613 |
$124K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,535 |
4,302 |
$121K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,427 |
1,257 |
$116K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,845 |
2,668 |
$104K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
1,011 |
941 |
$102K |
| A7035 |
Headgear used with positive airway pressure device |
6,670 |
6,292 |
$94K |
| K0004 |
High strength, lightweight wheelchair |
1,676 |
1,543 |
$93K |
| E0277 |
Powered pressure-reducing air mattress |
349 |
329 |
$73K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,504 |
2,347 |
$71K |
| K0002 |
Standard hemi (low seat) wheelchair |
1,219 |
1,144 |
$54K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,037 |
875 |
$53K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
11,021 |
10,339 |
$47K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
801 |
754 |
$46K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,268 |
4,885 |
$45K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
439 |
406 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,112 |
1,964 |
$29K |
| 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 |
401 |
334 |
$27K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,030 |
1,009 |
$23K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
389 |
382 |
$17K |
| A7037 |
Tubing used with positive airway pressure device |
823 |
773 |
$17K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
783 |
773 |
$14K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
112 |
101 |
$11K |
| K0007 |
Extra heavy duty wheelchair |
150 |
143 |
$11K |
| 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 |
219 |
190 |
$10K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
7,704 |
3,989 |
$10K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
213 |
197 |
$10K |
| K0006 |
Heavy duty wheelchair |
180 |
170 |
$10K |
| 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 |
175 |
150 |
$8K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
331 |
328 |
$8K |
| E0570 |
Nebulizer, with compressor |
592 |
582 |
$7K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
119 |
113 |
$7K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
73 |
72 |
$5K |
| A4623 |
Tracheostomy, inner cannula |
181 |
118 |
$4K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,344 |
2,239 |
$3K |
| T4541 |
Incontinence product, disposable underpad, large, each |
41 |
39 |
$3K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
3,134 |
1,571 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
817 |
410 |
$2K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
395 |
336 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
421 |
402 |
$1K |
| E1392 |
Portable oxygen concentrator, rental |
47 |
39 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
53 |
41 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
427 |
389 |
$907.50 |
| K0056 |
Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair |
61 |
56 |
$770.98 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,017 |
586 |
$654.54 |
| E0156 |
Seat attachment, walker |
50 |
43 |
$546.47 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$160.07 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
32 |
31 |
$14.23 |
| A7015 |
Aerosol mask, used with dme nebulizer |
15 |
15 |
$13.26 |