| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
471 |
258 |
$234K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,179 |
4,265 |
$227K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,566 |
3,108 |
$148K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
988 |
862 |
$107K |
| B9998 |
Noc for enteral supplies |
601 |
401 |
$74K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,065 |
905 |
$70K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,585 |
2,349 |
$68K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
577 |
424 |
$63K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
763 |
623 |
$58K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
145 |
114 |
$48K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,564 |
1,329 |
$43K |
| A7526 |
Tracheostomy tube collar/holder, each |
537 |
462 |
$38K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
203 |
174 |
$34K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
859 |
723 |
$33K |
| A4217 |
Sterile water/saline, 500 ml |
552 |
346 |
$33K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,483 |
2,198 |
$33K |
| 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 |
88 |
53 |
$31K |
| 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) |
420 |
365 |
$23K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
781 |
626 |
$21K |
| A7031 |
Face mask interface, replacement for full face mask, each |
901 |
773 |
$20K |
| A7035 |
Headgear used with positive airway pressure device |
1,456 |
1,247 |
$19K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
204 |
153 |
$16K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
184 |
151 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
747 |
624 |
$13K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
568 |
451 |
$10K |
| E0570 |
Nebulizer, with compressor |
561 |
509 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
441 |
352 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
820 |
716 |
$7K |
| 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 |
543 |
375 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
688 |
610 |
$7K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
172 |
144 |
$6K |
| K0001 |
Standard wheelchair |
482 |
448 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
678 |
504 |
$5K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
267 |
129 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,063 |
2,113 |
$5K |
| S8189 |
Tracheostomy supply, not otherwise classified |
87 |
55 |
$5K |
| E1392 |
Portable oxygen concentrator, rental |
310 |
292 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
388 |
318 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
34 |
29 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
205 |
187 |
$3K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
32 |
24 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
251 |
179 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
138 |
119 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
146 |
120 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
828 |
662 |
$2K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
265 |
118 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
192 |
156 |
$2K |
| A4618 |
Breathing circuits |
34 |
27 |
$971.00 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
17 |
14 |
$362.13 |
| A7525 |
Tracheostomy mask, each |
119 |
107 |
$249.94 |
| A4332 |
Lubricant, individual sterile packet, each |
152 |
136 |
$132.86 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
66 |
60 |
$41.54 |
| A4244 |
Alcohol or peroxide, per pint |
14 |
12 |
$17.19 |