| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
11,330 |
2,981 |
$7.85M |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
16,488 |
5,735 |
$5.38M |
| 99601 |
|
54,841 |
20,017 |
$5.31M |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
18,591 |
9,328 |
$4.52M |
| S9379 |
Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
6,849 |
3,255 |
$3.46M |
| S9366 |
Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
4,078 |
852 |
$2.75M |
| S9502 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
4,746 |
1,831 |
$1.78M |
| 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 |
3,126 |
2,355 |
$1.61M |
| J1745 |
Injection, infliximab, excludes biosimilar, 10 mg |
510 |
432 |
$1.54M |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
5,503 |
1,447 |
$1.29M |
| S9501 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
3,549 |
1,299 |
$1.20M |
| J1335 |
Injection, ertapenem sodium, 500 mg |
2,978 |
1,296 |
$1.14M |
| Q5103 |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
234 |
207 |
$1.09M |
| 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 |
3,162 |
2,328 |
$1.02M |
| S9365 |
Home infusion therapy, total parenteral nutrition (tpn); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
1,522 |
228 |
$811K |
| 99602 |
Nursing care in home rn |
5,867 |
3,808 |
$739K |
| J1561 |
Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg |
141 |
49 |
$579K |
| J0878 |
Injection, daptomycin, 1 mg |
1,792 |
516 |
$542K |
| S9367 |
Home infusion therapy, total parenteral nutrition (tpn); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
1,082 |
140 |
$415K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
4,767 |
1,861 |
$376K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,830 |
3,133 |
$364K |
| J3380 |
Injection, vedolizumab, intravenous, 1 mg |
43 |
39 |
$309K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
4,301 |
1,683 |
$262K |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
2,727 |
980 |
$254K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
2,236 |
876 |
$220K |
| S9542 |
Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
8,678 |
2,567 |
$219K |
| 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 |
2,378 |
1,621 |
$205K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,818 |
1,780 |
$205K |
| S9374 |
Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
1,053 |
299 |
$203K |
| J3370 |
Injection, vancomycin hcl, 500 mg |
2,976 |
825 |
$175K |
| S9338 |
Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
1,901 |
1,160 |
$170K |
| 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 |
1,852 |
1,280 |
$153K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
5,926 |
3,320 |
$126K |
| 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 |
362 |
296 |
$57K |
| J0692 |
Injection, cefepime hydrochloride, 500 mg |
448 |
192 |
$53K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
980 |
861 |
$43K |
| J2185 |
Injection, meropenem, 100 mg |
262 |
112 |
$41K |
| 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 |
193 |
129 |
$37K |
| J0690 |
Injection, cefazolin sodium, 500 mg |
570 |
178 |
$35K |
| 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 |
541 |
390 |
$28K |
| J0872 |
Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg |
23 |
12 |
$23K |
| J1580 |
Injection, garamycin, gentamicin, up to 80 mg |
2,249 |
1,540 |
$22K |
| 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 |
32 |
12 |
$22K |
| S9359 |
Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
195 |
185 |
$21K |
| 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 |
81 |
54 |
$20K |
| B4224 |
Parenteral nutrition administration kit, per day |
606 |
174 |
$19K |
| J0873 |
Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg |
48 |
16 |
$18K |
| B4180 |
Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix |
592 |
152 |
$18K |
| 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 |
68 |
40 |
$17K |
| S9503 |
Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
25 |
13 |
$11K |
| J2248 |
Injection, micafungin sodium, 1 mg |
31 |
12 |
$10K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
500 |
244 |
$9K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
239 |
67 |
$7K |
| J2543 |
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) |
58 |
25 |
$4K |
| J2260 |
Injection, milrinone lactate, 5 mg |
42 |
13 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
104 |
104 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
240 |
142 |
$983.29 |
| E0776 |
Iv pole |
12 |
12 |
$462.31 |
| A4927 |
Gloves, non-sterile, per 100 |
25 |
14 |
$301.15 |
| A4217 |
Sterile water/saline, 500 ml |
44 |
15 |
$163.74 |
| A4245 |
Alcohol wipes, per box |
40 |
30 |
$62.55 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
41 |
14 |
$29.70 |