| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,793 |
1,776 |
$991K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
3,276 |
2,501 |
$652K |
| E1399 |
Durable medical equipment, miscellaneous |
3,396 |
3,208 |
$643K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
1,093 |
1,056 |
$380K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
5,076 |
3,753 |
$327K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
5,846 |
5,509 |
$128K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
1,246 |
1,108 |
$98K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
26,178 |
25,714 |
$76K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
1,744 |
1,537 |
$74K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
839 |
812 |
$50K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,786 |
1,417 |
$49K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
672 |
572 |
$40K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
867 |
777 |
$40K |
| E2370 |
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
134 |
114 |
$38K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
853 |
694 |
$37K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
37,449 |
37,157 |
$33K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
859 |
778 |
$33K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
102,633 |
98,619 |
$29K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
10,496 |
10,317 |
$27K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
6,338 |
6,258 |
$25K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
19,606 |
19,422 |
$24K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
6,446 |
6,059 |
$22K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
219 |
217 |
$22K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
128 |
122 |
$14K |
| K0040 |
Adjustable angle footplate, each |
449 |
421 |
$12K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
115 |
107 |
$11K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
428 |
391 |
$10K |
| K0733 |
Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
419 |
400 |
$9K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,038 |
2,899 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,920 |
3,827 |
$6K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
201 |
183 |
$5K |
| E2624 |
Skin protection and positioning wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
90 |
82 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
3,196 |
3,047 |
$5K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
82,960 |
79,699 |
$5K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
97 |
88 |
$5K |
| K0019 |
Arm pad, replacement only, each |
585 |
539 |
$4K |
| E2374 |
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
39 |
36 |
$4K |
| E0570 |
Nebulizer, with compressor |
14,866 |
14,734 |
$4K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,771 |
8,678 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,906 |
10,744 |
$4K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
597 |
586 |
$4K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
646 |
608 |
$4K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,054 |
4,019 |
$4K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
82 |
77 |
$3K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
37 |
24 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
781 |
757 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
15,890 |
15,654 |
$3K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
506 |
501 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,786 |
11,711 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
1,029 |
906 |
$2K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,229 |
3,089 |
$2K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
860 |
828 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,420 |
1,397 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
77,203 |
75,107 |
$2K |
| K0001 |
Standard wheelchair |
28,152 |
27,379 |
$2K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
13 |
12 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
267 |
251 |
$2K |
| 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) |
4,720 |
4,563 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,296 |
2,034 |
$1K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,410 |
2,379 |
$1K |
| K0003 |
Lightweight wheelchair |
5,478 |
5,360 |
$1K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
122 |
116 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,537 |
6,451 |
$1K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
2,107 |
2,071 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13,621 |
13,231 |
$1K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
780 |
746 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
11,602 |
11,444 |
$937.43 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
7,244 |
6,836 |
$913.23 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
5,853 |
5,799 |
$891.48 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,094 |
2,973 |
$837.51 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
250 |
219 |
$805.94 |
| A4452 |
Tape, waterproof, per 18 square inches |
1,728 |
1,678 |
$618.90 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
15,550 |
15,400 |
$544.14 |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,038 |
1,007 |
$527.44 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,075 |
2,980 |
$517.50 |
| A7037 |
Tubing used with positive airway pressure device |
21,661 |
21,322 |
$504.31 |
| A5120 |
Skin barrier, wipes or swabs, each |
4,200 |
4,040 |
$477.39 |
| A7035 |
Headgear used with positive airway pressure device |
17,993 |
17,720 |
$388.07 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
986 |
874 |
$351.97 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,129 |
1,059 |
$344.90 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
10,529 |
10,432 |
$322.55 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,088 |
2,986 |
$320.75 |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
242 |
233 |
$312.96 |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,931 |
2,913 |
$298.99 |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
97 |
94 |
$294.00 |
| 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) |
12,803 |
12,429 |
$282.17 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
44,454 |
43,246 |
$279.70 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
137 |
133 |
$278.76 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
5,913 |
5,756 |
$272.93 |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
27 |
24 |
$239.13 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
981 |
856 |
$237.16 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,633 |
1,599 |
$234.52 |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
735 |
650 |
$231.03 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,044 |
3,906 |
$228.86 |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
275 |
253 |
$202.63 |
| E0245 |
Tub stool or bench |
697 |
693 |
$172.18 |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
17 |
13 |
$160.95 |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,793 |
1,710 |
$149.42 |
| K0007 |
Extra heavy duty wheelchair |
2,222 |
2,118 |
$143.16 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
13 |
12 |
$135.17 |
| A4367 |
Ostomy belt, each |
914 |
875 |
$132.69 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
8,892 |
8,613 |
$128.62 |
| E0635 |
Patient lift, electric with seat or sling |
446 |
435 |
$128.02 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,244 |
2,201 |
$123.78 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
34 |
25 |
$112.81 |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,417 |
5,355 |
$100.80 |
| A4322 |
Irrigation syringe, bulb or piston, each |
884 |
847 |
$99.24 |
| E1392 |
Portable oxygen concentrator, rental |
3,065 |
2,904 |
$99.03 |
| K0004 |
High strength, lightweight wheelchair |
14 |
13 |
$96.07 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
104 |
101 |
$91.97 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13,174 |
12,995 |
$90.04 |
| A4402 |
Lubricant, per ounce |
2,627 |
2,491 |
$89.72 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
25 |
24 |
$82.53 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,452 |
4,286 |
$77.14 |
| A4615 |
Cannula, nasal |
3,441 |
3,069 |
$75.58 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
4,114 |
3,976 |
$74.26 |
| E0156 |
Seat attachment, walker |
1,557 |
1,537 |
$69.69 |
| A7526 |
Tracheostomy tube collar/holder, each |
4,725 |
4,577 |
$65.70 |
| A7015 |
Aerosol mask, used with dme nebulizer |
7,921 |
7,859 |
$56.25 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
98 |
97 |
$54.92 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
8,488 |
8,267 |
$48.57 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
6,470 |
6,337 |
$47.72 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,488 |
1,414 |
$47.24 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
341 |
331 |
$45.36 |
| A4670 |
Automatic blood pressure monitor |
2,203 |
2,191 |
$38.50 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
647 |
601 |
$32.57 |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
353 |
341 |
$32.16 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
243 |
238 |
$25.01 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
126 |
125 |
$18.80 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,493 |
1,439 |
$15.03 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
337 |
333 |
$13.43 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
398 |
377 |
$11.59 |
| A4649 |
Surgical supply; miscellaneous |
8,602 |
6,826 |
$10.29 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,701 |
4,652 |
$9.59 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
489 |
479 |
$7.21 |
| A7012 |
Water collection device, used with large volume nebulizer |
2,082 |
2,011 |
$7.06 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,300 |
2,226 |
$7.05 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,929 |
3,708 |
$6.09 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,333 |
3,284 |
$3.39 |
| A7002 |
Tubing, used with suction pump, each |
6,584 |
5,987 |
$2.98 |
| A4217 |
Sterile water/saline, 500 ml |
1,583 |
1,521 |
$2.10 |
| A4332 |
Lubricant, individual sterile packet, each |
514 |
463 |
$1.06 |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,644 |
2,562 |
$0.00 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
189 |
176 |
$0.00 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
204 |
202 |
$0.00 |
| 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 |
9,631 |
7,822 |
$0.00 |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
586 |
562 |
$0.00 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
764 |
761 |
$0.00 |
| 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 |
929 |
848 |
$0.00 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
999 |
978 |
$0.00 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
974 |
941 |
$0.00 |
| 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 |
1,494 |
1,357 |
$0.00 |
| E0202 |
Phototherapy (bilirubin) light with photometer |
13 |
13 |
$0.00 |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,318 |
1,286 |
$0.00 |
| E0277 |
Powered pressure-reducing air mattress |
596 |
588 |
$0.00 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
653 |
617 |
$0.00 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
319 |
315 |
$0.00 |
| 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 |
3,649 |
3,155 |
$0.00 |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
404 |
357 |
$0.00 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,315 |
1,272 |
$0.00 |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
602 |
598 |
$0.00 |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,097 |
1,065 |
$0.00 |
| 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 |
4,650 |
4,131 |
$0.00 |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,289 |
1,254 |
$0.00 |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
590 |
578 |
$0.00 |
| 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 |
1,912 |
1,539 |
$0.00 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,005 |
953 |
$0.00 |
| E0619 |
Apnea monitor, with recording feature |
978 |
973 |
$0.00 |
| L8501 |
Tracheostomy speaking valve |
299 |
299 |
$0.00 |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
2,426 |
2,343 |
$0.00 |
| A4657 |
Syringe, with or without needle, each |
124 |
122 |
$0.00 |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
153 |
150 |
$0.00 |
| E0776 |
Iv pole |
833 |
828 |
$0.00 |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
186 |
167 |
$0.00 |
| B4100 |
Food thickener, administered orally, per ounce |
401 |
383 |
$0.00 |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
265 |
263 |
$0.00 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
14 |
14 |
$0.00 |
| B9998 |
Noc for enteral supplies |
234 |
226 |
$0.00 |
| K0053 |
Elevating footrests, articulating (telescoping), each |
12 |
12 |
$0.00 |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
12 |
12 |
$0.00 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
12 |
12 |
$0.00 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
966 |
955 |
$0.00 |
| A7000 |
Canister, disposable, used with suction pump, each |
6,085 |
5,877 |
$0.00 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,151 |
10,989 |
$0.00 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
562 |
540 |
$0.00 |
| E0244 |
Raised toilet seat |
42 |
42 |
$0.00 |
| A7525 |
Tracheostomy mask, each |
3,034 |
2,950 |
$0.00 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,268 |
3,108 |
$0.00 |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
3,149 |
3,052 |
$0.00 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,597 |
1,568 |
$0.00 |
| A4618 |
Breathing circuits |
1,810 |
1,737 |
$0.00 |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
629 |
606 |
$0.00 |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
296 |
281 |
$0.00 |
| A4605 |
Tracheal suction catheter, closed system, each |
585 |
568 |
$0.00 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
1,535 |
1,512 |
$0.00 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
2,091 |
2,048 |
$0.00 |
| E1372 |
Immersion external heater for nebulizer |
486 |
464 |
$0.00 |
| A4623 |
Tracheostomy, inner cannula |
844 |
788 |
$0.00 |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,158 |
1,119 |
$0.00 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,206 |
4,993 |
$0.00 |
| A7036 |
Chinstrap used with positive airway pressure device |
195 |
193 |
$0.00 |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
535 |
493 |
$0.00 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
250 |
245 |
$0.00 |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,797 |
3,779 |
$0.00 |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
335 |
305 |
$0.00 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
288 |
286 |
$0.00 |
| B4104 |
Additive for enteral formula (e.g., fiber) |
771 |
722 |
$0.00 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
104 |
103 |
$0.00 |
| B9002 |
Enteral nutrition infusion pump, any type |
11,060 |
10,896 |
$0.00 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,191 |
3,177 |
$0.00 |
| 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 |
474 |
414 |
$0.00 |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
195 |
192 |
$0.00 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
31 |
25 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
84 |
83 |
$0.00 |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$0.00 |
| 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 |
1,740 |
1,594 |
$0.00 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
19 |
17 |
$0.00 |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
15 |
15 |
$0.00 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
13 |
13 |
$0.00 |