| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
101,620 |
99,471 |
$35.99M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
82,797 |
76,007 |
$21.61M |
| T4541 |
Incontinence product, disposable underpad, large, each |
555,730 |
540,085 |
$16.36M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
359,126 |
345,931 |
$14.98M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
44,060 |
43,191 |
$12.61M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
247,718 |
239,842 |
$11.93M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
266,069 |
257,819 |
$11.54M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
162,559 |
156,777 |
$9.61M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
110,391 |
107,233 |
$8.41M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
10,603 |
9,753 |
$6.87M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
61,867 |
59,872 |
$6.02M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
12,030 |
11,210 |
$5.96M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
19,854 |
15,723 |
$5.75M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
73,630 |
71,060 |
$5.64M |
| E0784 |
External ambulatory infusion pump, insulin |
3,856 |
3,685 |
$5.56M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
98,035 |
95,278 |
$5.54M |
| 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 |
14,820 |
13,658 |
$5.00M |
| T5999 |
Supply, not otherwise specified |
9,608 |
7,276 |
$4.25M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
42,377 |
40,587 |
$4.19M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
42,705 |
42,343 |
$4.03M |
| A4453 |
Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
6,930 |
6,735 |
$3.53M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
33,310 |
29,127 |
$3.22M |
| E1399 |
Durable medical equipment, miscellaneous |
14,131 |
13,773 |
$2.82M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
24,812 |
23,384 |
$2.57M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
19,394 |
17,489 |
$2.48M |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
15,320 |
14,443 |
$2.23M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
36,349 |
35,197 |
$2.14M |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
20,455 |
20,232 |
$1.89M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
41,847 |
40,539 |
$1.74M |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
25,539 |
24,287 |
$1.62M |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
8,403 |
7,685 |
$1.62M |
| A4927 |
Gloves, non-sterile, per 100 |
196,004 |
187,386 |
$1.46M |
| 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 |
5,876 |
5,271 |
$1.40M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
32,047 |
29,550 |
$1.40M |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
6,142 |
5,686 |
$1.37M |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
20,578 |
19,541 |
$1.35M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
2,722 |
2,639 |
$1.33M |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
6,537 |
6,176 |
$1.18M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
8,707 |
8,342 |
$1.17M |
| A6260 |
Wound cleansers, any type, any size |
28,742 |
27,460 |
$1.09M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,591 |
5,366 |
$1.05M |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
5,868 |
5,327 |
$998K |
| A4322 |
Irrigation syringe, bulb or piston, each |
22,360 |
21,444 |
$966K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
7,095 |
6,518 |
$935K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
29,010 |
26,903 |
$899K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
5,612 |
5,096 |
$788K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
34,619 |
33,004 |
$759K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,009 |
6,656 |
$705K |
| B9998 |
Noc for enteral supplies |
10,196 |
9,082 |
$697K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
12,920 |
12,557 |
$697K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
1,366 |
1,322 |
$695K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
7,084 |
6,678 |
$655K |
| A4554 |
Disposable underpads, all sizes |
60,840 |
47,131 |
$646K |
| 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 |
11,168 |
10,469 |
$634K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
68,752 |
66,196 |
$629K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
13,548 |
12,641 |
$621K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
7,107 |
6,704 |
$610K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
23,071 |
22,060 |
$578K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
10,968 |
10,324 |
$576K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
5,528 |
5,460 |
$574K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
7,163 |
6,786 |
$551K |
| A5120 |
Skin barrier, wipes or swabs, each |
49,735 |
47,830 |
$548K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
24,659 |
24,289 |
$530K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
10,310 |
9,862 |
$505K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
916 |
801 |
$478K |
| 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 |
7,086 |
6,610 |
$474K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,694 |
5,219 |
$466K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,306 |
4,223 |
$429K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
2,553 |
2,357 |
$418K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
50,428 |
48,224 |
$417K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
20,832 |
19,700 |
$409K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
2,635 |
2,434 |
$403K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
3,610 |
3,349 |
$403K |
| A4335 |
Incontinence supply; miscellaneous |
58,935 |
57,503 |
$375K |
| 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 |
6,633 |
4,101 |
$367K |
| A4459 |
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
2,551 |
2,526 |
$356K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
6,085 |
5,685 |
$350K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
6,415 |
6,102 |
$348K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
3,926 |
3,754 |
$347K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
33,763 |
32,189 |
$341K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
3,705 |
3,545 |
$339K |
| A4456 |
Adhesive remover, wipes, any type, each |
36,122 |
34,952 |
$335K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
3,774 |
3,591 |
$310K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
15,293 |
14,792 |
$293K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,940 |
5,611 |
$284K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
1,651 |
1,526 |
$254K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
2,207 |
2,020 |
$253K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
4,439 |
4,274 |
$252K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
2,793 |
2,566 |
$250K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
30,921 |
28,871 |
$235K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
1,575 |
1,510 |
$234K |
| A7048 |
Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each |
195 |
174 |
$228K |
| A4217 |
Sterile water/saline, 500 ml |
10,453 |
10,036 |
$222K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
22,655 |
20,947 |
$221K |
| 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 |
4,388 |
2,607 |
$219K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
7,755 |
7,175 |
$212K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
680 |
637 |
$203K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
2,029 |
1,938 |
$178K |
| 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 |
1,497 |
1,142 |
$176K |
| A4402 |
Lubricant, per ounce |
23,632 |
22,881 |
$174K |
| A4452 |
Tape, waterproof, per 18 square inches |
10,189 |
9,016 |
$159K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
952 |
900 |
$155K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
2,633 |
2,473 |
$154K |
| A4371 |
Ostomy skin barrier, powder, per oz |
21,316 |
20,672 |
$148K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,549 |
2,355 |
$144K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
1,582 |
1,456 |
$139K |
| A4231 |
Infusion set for external insulin pump, needle type |
1,646 |
1,548 |
$130K |
| A4670 |
Automatic blood pressure monitor |
8,843 |
8,805 |
$129K |
| A4332 |
Lubricant, individual sterile packet, each |
9,958 |
9,607 |
$123K |
| A4649 |
Surgical supply; miscellaneous |
1,945 |
1,817 |
$119K |
| A4354 |
Insertion tray with drainage bag but without catheter |
213 |
205 |
$118K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,098 |
1,834 |
$117K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
5,041 |
4,715 |
$112K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
2,285 |
2,196 |
$104K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
896 |
800 |
$101K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
3,738 |
3,446 |
$95K |
| A4367 |
Ostomy belt, each |
12,069 |
11,700 |
$90K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,463 |
1,356 |
$87K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,744 |
1,693 |
$87K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,732 |
1,561 |
$78K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
1,137 |
1,091 |
$78K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
575 |
536 |
$74K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
1,132 |
1,066 |
$73K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
821 |
773 |
$66K |
| A4396 |
Ostomy belt with peristomal hernia support |
1,776 |
1,674 |
$65K |
| A5112 |
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each |
1,857 |
1,727 |
$64K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
1,257 |
1,040 |
$61K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
4,059 |
3,897 |
$60K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
7,371 |
7,029 |
$60K |
| A4930 |
Gloves, sterile, per pair |
710 |
661 |
$60K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
721 |
649 |
$60K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
511 |
480 |
$58K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
4,993 |
4,817 |
$57K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,064 |
2,045 |
$57K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
595 |
546 |
$56K |
| A4408 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
300 |
285 |
$55K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
2,805 |
2,651 |
$54K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
405 |
305 |
$48K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
9,834 |
9,060 |
$46K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,307 |
1,270 |
$45K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
1,614 |
1,433 |
$43K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
469 |
450 |
$35K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
7,549 |
7,288 |
$34K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,526 |
1,415 |
$33K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
1,457 |
1,392 |
$32K |
| A4421 |
Ostomy supply; miscellaneous |
545 |
530 |
$30K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
98 |
93 |
$29K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,396 |
2,280 |
$24K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
1,711 |
1,589 |
$24K |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
213 |
197 |
$22K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
914 |
870 |
$20K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
331 |
313 |
$19K |
| 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 |
20 |
17 |
$19K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,985 |
2,826 |
$17K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
1,135 |
1,056 |
$16K |
| A4400 |
Ostomy irrigation set |
229 |
220 |
$16K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
493 |
428 |
$15K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
160 |
145 |
$15K |
| 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 |
68 |
57 |
$15K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
294 |
272 |
$15K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
57 |
53 |
$15K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
676 |
629 |
$13K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,014 |
970 |
$13K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
722 |
704 |
$12K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
1,197 |
1,160 |
$12K |
| B4100 |
Food thickener, administered orally, per ounce |
167 |
164 |
$12K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
1,564 |
1,475 |
$10K |
| A9270 |
Non-covered item or service |
602 |
545 |
$10K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
345 |
324 |
$8K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
732 |
694 |
$8K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
180 |
129 |
$8K |
| E0325 |
Urinal; male, jug-type, any material |
586 |
577 |
$7K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
177 |
164 |
$7K |
| 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 |
304 |
178 |
$7K |
| A4245 |
Alcohol wipes, per box |
1,629 |
1,585 |
$6K |
| A5114 |
Leg strap; foam or fabric, replacement only, per set |
384 |
368 |
$6K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
255 |
247 |
$5K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
159 |
132 |
$5K |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
61 |
60 |
$4K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
266 |
250 |
$4K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
154 |
147 |
$4K |
| A4366 |
Ostomy vent, any type, each |
114 |
109 |
$3K |
| A4326 |
Male external catheter with integral collection chamber, any type, each |
15 |
15 |
$3K |
| A4363 |
Ostomy clamp, any type, replacement only, each |
371 |
350 |
$3K |
| A4398 |
Ostomy irrigation supply; bag, each |
131 |
125 |
$3K |
| A5055 |
Stoma cap |
69 |
62 |
$3K |
| A6243 |
Hydrogel 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 |
$3K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
82 |
81 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
48 |
39 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
59 |
59 |
$2K |
| E0607 |
Home blood glucose monitor |
43 |
43 |
$2K |
| A4259 |
Lancets, per box of 100 |
736 |
698 |
$2K |
| A6231 |
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing |
14 |
12 |
$2K |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
355 |
326 |
$2K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
148 |
145 |
$2K |
| A4256 |
Normal, low and high calibrator solution / chips |
275 |
255 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
97 |
97 |
$2K |
| S5199 |
Personal care item, nos, each |
133 |
117 |
$1K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
25 |
25 |
$898.06 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
19 |
19 |
$837.71 |
| E0241 |
Bath tub wall rail, each |
22 |
22 |
$628.00 |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
12 |
12 |
$576.94 |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
15 |
12 |
$460.82 |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
14 |
$277.20 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
20 |
20 |
$276.18 |