| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
19,298 |
3,068 |
$671K |
| 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 |
2,191 |
1,009 |
$657K |
| 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 |
2,058 |
1,193 |
$373K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,742 |
654 |
$289K |
| 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 |
1,261 |
852 |
$137K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
4,614 |
1,908 |
$97K |
| 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 |
542 |
275 |
$80K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,391 |
1,249 |
$78K |
| B4224 |
Parenteral nutrition administration kit, per day |
775 |
195 |
$68K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
242 |
132 |
$32K |
| B4100 |
Food thickener, administered orally, per ounce |
314 |
178 |
$21K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
776 |
196 |
$21K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
319 |
167 |
$16K |
| 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 |
125 |
57 |
$13K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
245 |
93 |
$13K |
| 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 |
255 |
137 |
$10K |
| B9998 |
Noc for enteral supplies |
132 |
116 |
$10K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,229 |
603 |
$8K |
| 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 |
19 |
12 |
$954.96 |