| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,933 |
14,741 |
$1.17M |
| E0601 |
Continuous positive airway pressure (cpap) device |
10,158 |
10,039 |
$514K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,549 |
1,542 |
$243K |
| 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 |
1,951 |
1,855 |
$217K |
| 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) |
1,956 |
1,916 |
$210K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12,296 |
12,120 |
$194K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,563 |
2,478 |
$165K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
5,702 |
5,639 |
$161K |
| E0570 |
Nebulizer, with compressor |
4,852 |
4,742 |
$146K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,003 |
991 |
$136K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
9,561 |
9,501 |
$121K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
1,365 |
1,358 |
$88K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,013 |
1,942 |
$82K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,096 |
2,046 |
$75K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,240 |
4,118 |
$75K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,720 |
1,583 |
$72K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,322 |
1,292 |
$71K |
| A7035 |
Headgear used with positive airway pressure device |
3,654 |
3,539 |
$67K |
| A7037 |
Tubing used with positive airway pressure device |
3,007 |
2,950 |
$62K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
1,102 |
1,097 |
$54K |
| K0001 |
Standard wheelchair |
3,093 |
3,016 |
$51K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
841 |
840 |
$46K |
| L3260 |
Surgical boot/shoe, each |
1,206 |
1,203 |
$36K |
| A7031 |
Face mask interface, replacement for full face mask, each |
938 |
895 |
$28K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
25 |
25 |
$16K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
239 |
229 |
$14K |
| K0003 |
Lightweight wheelchair |
360 |
356 |
$11K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
365 |
363 |
$11K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,546 |
1,518 |
$9K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
255 |
241 |
$8K |
| 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 |
60 |
54 |
$6K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
702 |
670 |
$5K |
| A4670 |
Automatic blood pressure monitor |
92 |
92 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
147 |
139 |
$5K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
116 |
87 |
$5K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
250 |
223 |
$4K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
39 |
39 |
$3K |
| E0156 |
Seat attachment, walker |
707 |
669 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
575 |
544 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
146 |
143 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
156 |
153 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
138 |
135 |
$2K |
| S5199 |
Personal care item, nos, each |
93 |
89 |
$840.34 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
34 |
31 |
$814.61 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
37 |
37 |
$481.71 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
14 |
$265.44 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
176 |
170 |
$199.56 |
| A4456 |
Adhesive remover, wipes, any type, each |
25 |
25 |
$194.40 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
67 |
37 |
$191.10 |
| A4259 |
Lancets, per box of 100 |
67 |
66 |
$66.71 |
| E1392 |
Portable oxygen concentrator, rental |
12 |
12 |
$59.66 |