| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
83,439 |
64,167 |
$65.08M |
| 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 |
101,502 |
80,787 |
$22.25M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
97,216 |
74,991 |
$19.36M |
| 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 |
30,491 |
23,237 |
$9.67M |
| B4189 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix |
8,123 |
1,807 |
$7.32M |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
58,794 |
46,248 |
$6.40M |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
8,977 |
6,540 |
$4.44M |
| J1569 |
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg |
274 |
169 |
$4.02M |
| 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 |
6,404 |
4,781 |
$3.05M |
| B9002 |
Enteral nutrition infusion pump, any type |
38,806 |
34,288 |
$2.86M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
5,987 |
5,460 |
$2.52M |
| 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 |
14,361 |
10,648 |
$2.26M |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
12,178 |
5,372 |
$2.08M |
| 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 |
16,982 |
12,848 |
$2.03M |
| 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 |
14,756 |
11,341 |
$1.72M |
| B4224 |
Parenteral nutrition administration kit, per day |
23,472 |
3,146 |
$1.56M |
| A7030 |
Full face mask used with positive airway pressure device, each |
19,077 |
17,617 |
$1.55M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
4,807 |
4,352 |
$1.47M |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
5,537 |
1,915 |
$1.31M |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,483 |
7,007 |
$1.23M |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,712 |
2,078 |
$1.14M |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
32,437 |
30,089 |
$1.12M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
52,337 |
43,939 |
$1.01M |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
5,121 |
4,140 |
$943K |
| A7031 |
Face mask interface, replacement for full face mask, each |
22,352 |
20,210 |
$888K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
13,257 |
2,893 |
$847K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14,283 |
13,322 |
$764K |
| E0601 |
Continuous positive airway pressure (cpap) device |
16,100 |
14,909 |
$684K |
| B4197 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix |
733 |
143 |
$599K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
5,577 |
4,361 |
$591K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
25,147 |
11,426 |
$559K |
| B9004 |
Parenteral nutrition infusion pump, portable |
2,038 |
1,600 |
$533K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
9,607 |
8,610 |
$526K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
14,660 |
3,139 |
$509K |
| 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 |
12,985 |
10,213 |
$508K |
| B4100 |
Food thickener, administered orally, per ounce |
16,318 |
10,783 |
$507K |
| V5261 |
Hearing aid, digital, binaural, bte |
522 |
450 |
$389K |
| E0776 |
Iv pole |
3,901 |
3,452 |
$364K |
| A7035 |
Headgear used with positive airway pressure device |
18,956 |
17,623 |
$333K |
| J3490 |
Unclassified drugs |
3,457 |
1,083 |
$290K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
6,596 |
5,956 |
$282K |
| 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) |
3,258 |
2,961 |
$275K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,973 |
2,379 |
$274K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,553 |
7,032 |
$273K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
40,144 |
36,050 |
$252K |
| V5266 |
Battery for use in hearing device |
3,391 |
3,102 |
$204K |
| B4081 |
Nasogastric tubing with stylet |
7,869 |
6,053 |
$167K |
| J1459 |
Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg |
15 |
13 |
$165K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13,894 |
12,890 |
$151K |
| V5264 |
Ear mold/insert, not disposable, any type |
2,866 |
2,645 |
$145K |
| 99601 |
|
571 |
322 |
$92K |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
59 |
38 |
$63K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
1,463 |
521 |
$62K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
7,282 |
2,814 |
$48K |
| A6025 |
Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each |
1,222 |
888 |
$46K |
| V5257 |
Hearing aid, digital, monaural, bte |
109 |
96 |
$39K |
| B4193 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix |
49 |
12 |
$36K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
197 |
170 |
$34K |
| J2997 |
Injection, alteplase recombinant, 1 mg |
72 |
51 |
$33K |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
2,283 |
559 |
$31K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
59 |
51 |
$23K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
131 |
120 |
$20K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
610 |
319 |
$19K |
| E1399 |
Durable medical equipment, miscellaneous |
2,496 |
1,182 |
$17K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,276 |
1,200 |
$12K |
| B4159 |
Enteral formula, for pediatrics, nutritionally complete soy based 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 |
63 |
38 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
657 |
598 |
$8K |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
1,253 |
729 |
$8K |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
113 |
36 |
$7K |
| V5267 |
Hearing aid or assistive listening device/supplies/accessories, not otherwise specified |
741 |
653 |
$7K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
42 |
26 |
$6K |
| A6504 |
Compression burn garment, glove to wrist, custom fabricated |
42 |
25 |
$5K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
188 |
74 |
$4K |
| 99602 |
Nursing care in home rn |
33 |
15 |
$4K |
| A6511 |
Compression burn garment, lower trunk including leg openings (panty), custom fabricated |
36 |
24 |
$3K |
| A6512 |
Compression burn garment, not otherwise classified |
62 |
40 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
277 |
251 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
85 |
74 |
$1K |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
50 |
26 |
$1K |
| J7050 |
Infusion, normal saline solution, 250 cc |
999 |
540 |
$1K |
| S9340 |
Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
1,335 |
1,218 |
$1K |
| J2260 |
Injection, milrinone lactate, 5 mg |
37 |
12 |
$1K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
39 |
12 |
$984.28 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
84 |
63 |
$851.64 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
191 |
148 |
$427.38 |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
25 |
12 |
$391.08 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
29 |
13 |
$228.04 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
43 |
17 |
$113.84 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
18 |
12 |
$44.26 |
| A7000 |
Canister, disposable, used with suction pump, each |
20 |
14 |
$0.00 |