| 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 |
19,098 |
19,019 |
$554K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
712 |
712 |
$222K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,647 |
2,425 |
$133K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,625 |
13,555 |
$86K |
| 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 |
811 |
738 |
$64K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,213 |
1,209 |
$23K |
| 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 |
476 |
448 |
$20K |
| 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 |
434 |
389 |
$19K |
| E1392 |
Portable oxygen concentrator, rental |
1,258 |
1,255 |
$18K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
658 |
657 |
$14K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,017 |
1,012 |
$14K |
| E0570 |
Nebulizer, with compressor |
9,960 |
9,931 |
$14K |
| B9002 |
Enteral nutrition infusion pump, any type |
585 |
581 |
$13K |
| E0601 |
Continuous positive airway pressure (cpap) device |
632 |
628 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,815 |
1,798 |
$8K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
202 |
201 |
$7K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
166 |
165 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
689 |
685 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,332 |
1,330 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,313 |
3,160 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
289 |
289 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
51 |
50 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
390 |
389 |
$1K |
| E0776 |
Iv pole |
363 |
363 |
$784.94 |
| A7037 |
Tubing used with positive airway pressure device |
77 |
77 |
$443.04 |
| A7030 |
Full face mask used with positive airway pressure device, each |
27 |
27 |
$338.66 |
| A7015 |
Aerosol mask, used with dme nebulizer |
519 |
491 |
$157.81 |