| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
7,600 |
2,244 |
$6.26M |
| 90378 |
|
1,336 |
847 |
$2.56M |
| B4197 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix |
1,910 |
485 |
$1.72M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
26,969 |
24,956 |
$1.51M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,242 |
8,044 |
$1.07M |
| E0601 |
Continuous positive airway pressure (cpap) device |
16,967 |
16,389 |
$999K |
| 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 |
1,646 |
1,231 |
$525K |
| 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 |
1,558 |
1,155 |
$487K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
21,866 |
20,327 |
$477K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
4,243 |
1,133 |
$444K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,640 |
2,498 |
$413K |
| A4649 |
Surgical supply; miscellaneous |
23,938 |
1,193 |
$382K |
| B4224 |
Parenteral nutrition administration kit, per day |
8,618 |
1,846 |
$353K |
| 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 |
3,676 |
2,703 |
$321K |
| 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) |
2,033 |
1,945 |
$278K |
| 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 |
2,005 |
1,391 |
$266K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,569 |
3,336 |
$256K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
5,146 |
1,320 |
$248K |
| B4199 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix |
275 |
76 |
$233K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,068 |
4,743 |
$174K |
| 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 |
2,101 |
1,461 |
$161K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,667 |
1,562 |
$147K |
| A7035 |
Headgear used with positive airway pressure device |
5,231 |
4,943 |
$123K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
8,141 |
1,807 |
$123K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
582 |
542 |
$119K |
| 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) |
540 |
460 |
$113K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,627 |
2,496 |
$111K |
| E0570 |
Nebulizer, with compressor |
4,061 |
3,769 |
$106K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,120 |
1,849 |
$106K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,254 |
1,039 |
$85K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
4,187 |
1,871 |
$73K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,713 |
1,363 |
$61K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,346 |
2,207 |
$53K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,552 |
1,426 |
$47K |
| S9560 |
Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
1,059 |
747 |
$42K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
150 |
52 |
$32K |
| S9542 |
Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
722 |
531 |
$31K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,897 |
2,771 |
$25K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,007 |
1,014 |
$24K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,284 |
5,888 |
$20K |
| S9562 |
Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
944 |
784 |
$18K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,177 |
1,106 |
$17K |
| E1392 |
Portable oxygen concentrator, rental |
559 |
518 |
$16K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
157 |
64 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
479 |
452 |
$9K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
172 |
142 |
$9K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
188 |
178 |
$8K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
223 |
67 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,209 |
1,124 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
238 |
218 |
$4K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
113 |
103 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
60 |
50 |
$808.88 |
| A7526 |
Tracheostomy tube collar/holder, each |
27 |
24 |
$621.01 |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
34 |
12 |
$494.14 |
| A7015 |
Aerosol mask, used with dme nebulizer |
214 |
204 |
$277.35 |
| A7002 |
Tubing, used with suction pump, each |
39 |
36 |
$269.59 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
288 |
238 |
$253.59 |
| 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 |
14 |
12 |
$248.50 |