| 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 |
58,752 |
45,771 |
$2.44M |
| 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 |
4,203 |
3,250 |
$2.18M |
| 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 |
6,951 |
5,634 |
$1.27M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,542 |
2,494 |
$1.23M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,564 |
4,139 |
$804K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12,890 |
10,019 |
$793K |
| A7031 |
Face mask interface, replacement for full face mask, each |
22,648 |
18,632 |
$727K |
| E0601 |
Continuous positive airway pressure (cpap) device |
19,374 |
15,455 |
$706K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
16,454 |
13,105 |
$433K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
40,719 |
31,635 |
$360K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
23,244 |
18,814 |
$276K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,096 |
4,944 |
$227K |
| 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) |
2,853 |
2,063 |
$203K |
| 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 |
2,148 |
1,564 |
$193K |
| E0570 |
Nebulizer, with compressor |
15,144 |
11,096 |
$191K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
5,582 |
4,663 |
$186K |
| 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 |
1,748 |
1,274 |
$167K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,797 |
1,934 |
$154K |
| A7035 |
Headgear used with positive airway pressure device |
11,149 |
8,813 |
$143K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,539 |
2,089 |
$136K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
34,432 |
28,591 |
$136K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,169 |
3,368 |
$134K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
4,660 |
4,028 |
$128K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,515 |
2,284 |
$95K |
| E1130 |
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests |
2,285 |
1,976 |
$74K |
| E1392 |
Portable oxygen concentrator, rental |
5,617 |
4,280 |
$71K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
8,911 |
7,075 |
$67K |
| E0619 |
Apnea monitor, with recording feature |
395 |
340 |
$60K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
424 |
396 |
$52K |
| 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 |
128 |
102 |
$44K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,477 |
1,680 |
$39K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,482 |
1,166 |
$32K |
| A7037 |
Tubing used with positive airway pressure device |
3,048 |
2,355 |
$31K |
| 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 |
222 |
156 |
$26K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,399 |
1,149 |
$24K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
290 |
249 |
$19K |
| E0776 |
Iv pole |
2,330 |
1,849 |
$17K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,412 |
1,022 |
$17K |
| 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 |
83 |
65 |
$14K |
| 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 |
250 |
206 |
$10K |
| E0156 |
Seat attachment, walker |
859 |
676 |
$8K |
| A4623 |
Tracheostomy, inner cannula |
37 |
26 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,703 |
3,664 |
$5K |
| K0001 |
Standard wheelchair |
3,542 |
2,940 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
257 |
203 |
$3K |
| E1160 |
Wheelchair, fixed full length arms, swing away detachable elevating legrests |
53 |
38 |
$3K |
| B9998 |
Noc for enteral supplies |
316 |
261 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
966 |
682 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,294 |
984 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
34 |
25 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
98 |
78 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,970 |
1,532 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
310 |
234 |
$1K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
214 |
156 |
$969.98 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
25 |
15 |
$620.27 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,659 |
1,244 |
$603.12 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
30 |
26 |
$547.23 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
13 |
12 |
$437.02 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
449 |
369 |
$279.99 |
| A7036 |
Chinstrap used with positive airway pressure device |
28 |
25 |
$277.86 |
| A7002 |
Tubing, used with suction pump, each |
13 |
12 |
$68.08 |
| A7525 |
Tracheostomy mask, each |
21 |
12 |
$2.37 |