| 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 |
7,974 |
7,658 |
$444K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
4,937 |
1,849 |
$402K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
5,488 |
3,909 |
$296K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,536 |
6,414 |
$287K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
2,344 |
2,068 |
$284K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
543 |
488 |
$265K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
310 |
269 |
$205K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,505 |
2,440 |
$149K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,126 |
2,975 |
$131K |
| E1399 |
Durable medical equipment, miscellaneous |
457 |
76 |
$125K |
| 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) |
962 |
934 |
$118K |
| K0003 |
Lightweight wheelchair |
2,533 |
2,433 |
$106K |
| E0570 |
Nebulizer, with compressor |
2,310 |
2,218 |
$101K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,440 |
902 |
$95K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,629 |
4,467 |
$94K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
587 |
523 |
$89K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
3,280 |
2,780 |
$88K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
602 |
586 |
$86K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,286 |
1,033 |
$85K |
| 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 |
863 |
570 |
$78K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
620 |
523 |
$78K |
| K0001 |
Standard wheelchair |
2,762 |
2,636 |
$73K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
135 |
100 |
$67K |
| 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) |
274 |
273 |
$64K |
| A7035 |
Headgear used with positive airway pressure device |
3,078 |
3,009 |
$60K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,631 |
1,594 |
$59K |
| E2609 |
Custom fabricated wheelchair seat cushion, any size |
125 |
90 |
$54K |
| A7037 |
Tubing used with positive airway pressure device |
3,505 |
3,427 |
$51K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
315 |
313 |
$48K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
874 |
674 |
$38K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,021 |
959 |
$32K |
| 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 |
697 |
433 |
$32K |
| K0040 |
Adjustable angle footplate, each |
416 |
310 |
$29K |
| K0004 |
High strength, lightweight wheelchair |
500 |
444 |
$28K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
370 |
190 |
$28K |
| 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 |
951 |
924 |
$23K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
185 |
158 |
$23K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
581 |
495 |
$20K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
600 |
428 |
$18K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
423 |
288 |
$17K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
223 |
187 |
$16K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
17 |
13 |
$13K |
| K0007 |
Extra heavy duty wheelchair |
66 |
62 |
$12K |
| 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 |
78 |
75 |
$12K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
574 |
502 |
$12K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
196 |
189 |
$12K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,214 |
5,015 |
$11K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,446 |
1,404 |
$11K |
| E0245 |
Tub stool or bench |
301 |
298 |
$11K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
304 |
292 |
$9K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
146 |
105 |
$9K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
284 |
264 |
$8K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
290 |
271 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,550 |
1,438 |
$6K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
31 |
25 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,669 |
1,329 |
$5K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
47 |
38 |
$5K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
270 |
261 |
$5K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
15 |
12 |
$5K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
40 |
40 |
$4K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
97 |
70 |
$4K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
14 |
13 |
$3K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
220 |
204 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
231 |
152 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
100 |
95 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,108 |
1,010 |
$3K |
| E0277 |
Powered pressure-reducing air mattress |
15 |
14 |
$3K |
| K0006 |
Heavy duty wheelchair |
12 |
12 |
$2K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
15 |
12 |
$2K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
45 |
36 |
$2K |
| E0156 |
Seat attachment, walker |
296 |
280 |
$2K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
68 |
64 |
$2K |
| K0019 |
Arm pad, replacement only, each |
216 |
156 |
$2K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
56 |
43 |
$2K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
24 |
14 |
$2K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
15 |
12 |
$2K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
13 |
13 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
273 |
264 |
$2K |
| E0244 |
Raised toilet seat |
39 |
39 |
$2K |
| 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 |
17 |
12 |
$1K |
| E0950 |
Wheelchair accessory, tray, each |
14 |
13 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
242 |
232 |
$923.03 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
32 |
25 |
$803.90 |
| A7036 |
Chinstrap used with positive airway pressure device |
78 |
77 |
$668.08 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
22 |
12 |
$525.83 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
39 |
39 |
$217.83 |