| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,513 |
1,041 |
$990K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,684 |
3,384 |
$801K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
5,376 |
3,813 |
$764K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
4,687 |
3,840 |
$725K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
2,042 |
1,683 |
$511K |
| A4554 |
Disposable underpads, all sizes |
9,047 |
7,589 |
$474K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,016 |
1,672 |
$380K |
| E1399 |
Durable medical equipment, miscellaneous |
2,077 |
888 |
$347K |
| 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 |
873 |
768 |
$346K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
8,924 |
7,216 |
$320K |
| K0001 |
Standard wheelchair |
9,233 |
7,773 |
$317K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
10,157 |
6,934 |
$283K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
13,421 |
11,372 |
$277K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,030 |
1,428 |
$238K |
| K0003 |
Lightweight wheelchair |
3,478 |
2,700 |
$238K |
| A4927 |
Gloves, non-sterile, per 100 |
12,284 |
8,311 |
$231K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
2,567 |
2,285 |
$221K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,937 |
2,438 |
$209K |
| K0004 |
High strength, lightweight wheelchair |
3,175 |
2,595 |
$193K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,927 |
1,410 |
$174K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,110 |
919 |
$166K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
3,604 |
1,653 |
$157K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,553 |
2,613 |
$155K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
3,565 |
2,824 |
$130K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
2,993 |
2,036 |
$122K |
| E0570 |
Nebulizer, with compressor |
2,956 |
2,387 |
$98K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
2,334 |
2,077 |
$95K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,508 |
2,197 |
$90K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,020 |
1,683 |
$85K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
443 |
360 |
$76K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
238 |
197 |
$62K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
765 |
625 |
$58K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
899 |
746 |
$57K |
| K0006 |
Heavy duty wheelchair |
459 |
350 |
$52K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,571 |
1,402 |
$49K |
| E0245 |
Tub stool or bench |
1,123 |
1,014 |
$49K |
| 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 |
650 |
412 |
$42K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
93 |
76 |
$41K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
267 |
214 |
$38K |
| E0156 |
Seat attachment, walker |
3,370 |
2,572 |
$37K |
| T5001 |
Positioning seat for persons with special orthopedic needs |
42 |
25 |
$33K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,025 |
762 |
$31K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
1,384 |
1,219 |
$31K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,975 |
1,600 |
$27K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
626 |
511 |
$24K |
| B9998 |
Noc for enteral supplies |
429 |
161 |
$24K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
179 |
152 |
$23K |
| E0700 |
Safety equipment, device or accessory, any type |
272 |
254 |
$21K |
| A4553 |
Non-disposable underpads, all sizes |
1,642 |
1,135 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,668 |
1,694 |
$18K |
| E0140 |
Walker, with trunk support, adjustable or fixed height, any type |
85 |
64 |
$15K |
| E0184 |
Dry pressure mattress |
149 |
104 |
$12K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
548 |
400 |
$12K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,061 |
747 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,242 |
1,562 |
$11K |
| A4670 |
Automatic blood pressure monitor |
151 |
137 |
$10K |
| A6260 |
Wound cleansers, any type, any size |
523 |
364 |
$10K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
37 |
26 |
$9K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
56 |
24 |
$8K |
| E0244 |
Raised toilet seat |
291 |
253 |
$7K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
134 |
125 |
$7K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
316 |
246 |
$5K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
249 |
166 |
$5K |
| K0007 |
Extra heavy duty wheelchair |
14 |
12 |
$5K |
| A4930 |
Gloves, sterile, per pair |
39 |
26 |
$4K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
144 |
90 |
$4K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
619 |
404 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
12 |
$3K |
| E0705 |
Transfer device, any type, each |
110 |
52 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
285 |
176 |
$2K |
| 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 |
20 |
12 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
32 |
12 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,857 |
1,666 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
220 |
184 |
$2K |
| E0154 |
Platform attachment, walker, each |
26 |
19 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
17 |
13 |
$2K |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
31 |
26 |
$1K |
| A4332 |
Lubricant, individual sterile packet, each |
140 |
111 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
192 |
130 |
$1K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
33 |
27 |
$987.24 |
| A4322 |
Irrigation syringe, bulb or piston, each |
57 |
37 |
$885.63 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
21 |
14 |
$646.23 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
12 |
$163.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13 |
12 |
$161.70 |
| A4456 |
Adhesive remover, wipes, any type, each |
24 |
12 |
$115.00 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
17 |
12 |
$46.39 |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
46 |
24 |
$0.00 |