| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,099 |
1,608 |
$2.34M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,860 |
4,441 |
$974K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,490 |
1,447 |
$930K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
9,330 |
8,927 |
$733K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,853 |
3,715 |
$544K |
| B9002 |
Enteral nutrition infusion pump, any type |
7,782 |
7,555 |
$541K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
2,936 |
2,840 |
$514K |
| 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 |
926 |
792 |
$332K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,195 |
3,179 |
$273K |
| 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 |
1,346 |
1,247 |
$268K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
9,687 |
4,454 |
$227K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
351 |
319 |
$203K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,984 |
6,722 |
$196K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,022 |
1,906 |
$189K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
639 |
585 |
$155K |
| B9998 |
Noc for enteral supplies |
402 |
348 |
$129K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,643 |
1,585 |
$107K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
848 |
496 |
$96K |
| 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) |
299 |
279 |
$93K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
1,694 |
1,507 |
$86K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,862 |
2,681 |
$70K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
503 |
444 |
$57K |
| A4554 |
Disposable underpads, all sizes |
1,320 |
1,265 |
$55K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,009 |
2,794 |
$51K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
612 |
575 |
$49K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,296 |
3,040 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
3,854 |
3,517 |
$43K |
| E0570 |
Nebulizer, with compressor |
441 |
434 |
$39K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,843 |
1,740 |
$37K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
3,647 |
3,285 |
$34K |
| K0001 |
Standard wheelchair |
1,043 |
1,031 |
$32K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
888 |
838 |
$31K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,045 |
976 |
$29K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,025 |
907 |
$27K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,092 |
1,048 |
$27K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,143 |
1,062 |
$27K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
335 |
286 |
$26K |
| E0619 |
Apnea monitor, with recording feature |
162 |
156 |
$25K |
| A4245 |
Alcohol wipes, per box |
1,447 |
1,373 |
$23K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,709 |
1,586 |
$23K |
| E0776 |
Iv pole |
2,031 |
1,977 |
$23K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,466 |
2,332 |
$20K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
180 |
168 |
$18K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
210 |
206 |
$14K |
| A4332 |
Lubricant, individual sterile packet, each |
1,160 |
1,101 |
$12K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
123 |
109 |
$11K |
| 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 |
232 |
206 |
$11K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
1,565 |
1,480 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,859 |
1,783 |
$11K |
| A7002 |
Tubing, used with suction pump, each |
3,083 |
2,897 |
$9K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
974 |
917 |
$8K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
138 |
116 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
919 |
852 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
529 |
520 |
$6K |
| A4244 |
Alcohol or peroxide, per pint |
1,622 |
1,482 |
$4K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
436 |
416 |
$3K |
| 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) |
27 |
24 |
$3K |
| A7525 |
Tracheostomy mask, each |
545 |
519 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
326 |
262 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$750.31 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
31 |
31 |
$724.78 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
27 |
24 |
$230.92 |
| A7012 |
Water collection device, used with large volume nebulizer |
19 |
13 |
$72.23 |