| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,012 |
2,928 |
$1.50M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,704 |
1,457 |
$894K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,838 |
9,705 |
$610K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,299 |
1,037 |
$144K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,450 |
916 |
$131K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,084 |
1,044 |
$106K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,220 |
6,516 |
$96K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
575 |
484 |
$71K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
482 |
372 |
$66K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
978 |
686 |
$65K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,657 |
1,330 |
$57K |
| A7030 |
Full face mask used with positive airway pressure device, each |
837 |
672 |
$48K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
430 |
358 |
$45K |
| A4605 |
Tracheal suction catheter, closed system, each |
681 |
577 |
$42K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
657 |
526 |
$40K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
500 |
417 |
$39K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,237 |
1,182 |
$35K |
| A4217 |
Sterile water/saline, 500 ml |
1,044 |
856 |
$35K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
624 |
486 |
$29K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,170 |
963 |
$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 |
1,234 |
1,160 |
$25K |
| E1392 |
Portable oxygen concentrator, rental |
678 |
591 |
$25K |
| A4927 |
Gloves, non-sterile, per 100 |
985 |
851 |
$23K |
| E0601 |
Continuous positive airway pressure (cpap) device |
897 |
728 |
$21K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
291 |
241 |
$19K |
| E0570 |
Nebulizer, with compressor |
1,904 |
1,845 |
$18K |
| A7031 |
Face mask interface, replacement for full face mask, each |
923 |
600 |
$18K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
396 |
347 |
$17K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
552 |
494 |
$15K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
75 |
68 |
$15K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
996 |
866 |
$15K |
| A4623 |
Tracheostomy, inner cannula |
150 |
109 |
$14K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,543 |
1,237 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,157 |
1,827 |
$12K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
729 |
628 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,653 |
1,412 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
841 |
680 |
$10K |
| A4649 |
Surgical supply; miscellaneous |
23 |
14 |
$10K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
38 |
37 |
$9K |
| 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) |
186 |
160 |
$8K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
62 |
53 |
$7K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
312 |
305 |
$7K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
97 |
89 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,708 |
1,150 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
817 |
692 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
1,658 |
1,411 |
$5K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
104 |
87 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
144 |
114 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
79 |
79 |
$4K |
| K0001 |
Standard wheelchair |
164 |
157 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,255 |
1,133 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
560 |
455 |
$4K |
| A4452 |
Tape, waterproof, per 18 square inches |
276 |
251 |
$3K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
105 |
95 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
421 |
374 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
26 |
26 |
$2K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
469 |
409 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
370 |
332 |
$1K |
| A7525 |
Tracheostomy mask, each |
716 |
607 |
$1K |
| L8501 |
Tracheostomy speaking valve |
12 |
12 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
137 |
130 |
$942.49 |
| A7015 |
Aerosol mask, used with dme nebulizer |
403 |
354 |
$431.58 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
13 |
12 |
$165.33 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
31 |
26 |
$147.06 |
| A4332 |
Lubricant, individual sterile packet, each |
16 |
13 |
$124.86 |