| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
979 |
838 |
$759K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,220 |
960 |
$716K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,153 |
2,623 |
$670K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,785 |
5,515 |
$485K |
| 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 |
601 |
259 |
$448K |
| 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 |
1,336 |
742 |
$445K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,584 |
1,170 |
$118K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,183 |
1,144 |
$87K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
166 |
165 |
$71K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,064 |
3,915 |
$68K |
| 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 |
488 |
158 |
$54K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,283 |
1,201 |
$42K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,210 |
1,086 |
$38K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,067 |
942 |
$27K |
| A4217 |
Sterile water/saline, 500 ml |
447 |
373 |
$23K |
| A7030 |
Full face mask used with positive airway pressure device, each |
435 |
364 |
$21K |
| A7526 |
Tracheostomy tube collar/holder, each |
405 |
359 |
$21K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
686 |
611 |
$15K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
706 |
616 |
$14K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
102 |
90 |
$11K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,114 |
1,005 |
$10K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
175 |
162 |
$10K |
| A7031 |
Face mask interface, replacement for full face mask, each |
558 |
453 |
$9K |
| E0570 |
Nebulizer, with compressor |
463 |
430 |
$9K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
132 |
96 |
$9K |
| 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 |
245 |
106 |
$8K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
168 |
64 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
1,252 |
1,083 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,236 |
1,073 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
74 |
62 |
$3K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
119 |
98 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
286 |
252 |
$3K |
| K0001 |
Standard wheelchair |
189 |
170 |
$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) |
26 |
24 |
$3K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
30 |
14 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
269 |
226 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
40 |
31 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
305 |
262 |
$2K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
98 |
27 |
$1K |
| 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 |
30 |
12 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
27 |
24 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
52 |
49 |
$551.70 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
76 |
63 |
$151.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
41 |
37 |
$72.12 |