| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
7,631 |
6,650 |
$4.08M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
21,284 |
17,048 |
$4.03M |
| 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 |
4,826 |
4,410 |
$3.13M |
| 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 |
10,385 |
8,776 |
$2.39M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
23,767 |
22,949 |
$2.12M |
| B9998 |
Noc for enteral supplies |
29,617 |
19,849 |
$1.85M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,313 |
3,166 |
$1.72M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
19,819 |
14,857 |
$1.58M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
8,152 |
7,876 |
$1.50M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,146 |
1,894 |
$1.07M |
| 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 |
2,989 |
2,560 |
$951K |
| A4554 |
Disposable underpads, all sizes |
25,764 |
24,701 |
$947K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
7,526 |
7,174 |
$945K |
| 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 |
1,014 |
972 |
$820K |
| 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 |
3,995 |
3,631 |
$814K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,026 |
6,505 |
$811K |
| A4605 |
Tracheal suction catheter, closed system, each |
5,262 |
3,704 |
$653K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
7,000 |
6,495 |
$610K |
| 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 |
2,992 |
2,683 |
$606K |
| A7000 |
Canister, disposable, used with suction pump, each |
22,814 |
17,957 |
$587K |
| 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) |
2,187 |
2,095 |
$539K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
8,465 |
7,639 |
$527K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,287 |
5,139 |
$496K |
| A6210 |
Foam 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 |
2,487 |
1,676 |
$440K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
23,013 |
22,277 |
$361K |
| 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 |
994 |
930 |
$354K |
| 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 |
2,414 |
2,231 |
$345K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,420 |
3,817 |
$296K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,493 |
3,261 |
$292K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,559 |
2,488 |
$280K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
505 |
493 |
$272K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,915 |
2,769 |
$258K |
| A7002 |
Tubing, used with suction pump, each |
19,402 |
18,535 |
$258K |
| 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 |
1,245 |
1,165 |
$240K |
| A7526 |
Tracheostomy tube collar/holder, each |
11,202 |
8,985 |
$228K |
| K0001 |
Standard wheelchair |
7,126 |
6,939 |
$218K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
1,350 |
1,312 |
$215K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,011 |
1,797 |
$209K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,365 |
1,120 |
$208K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,161 |
2,013 |
$195K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,266 |
4,791 |
$179K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,422 |
1,347 |
$169K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,697 |
1,607 |
$158K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,114 |
2,035 |
$154K |
| 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) |
1,162 |
1,123 |
$152K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,720 |
2,602 |
$152K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,248 |
1,146 |
$131K |
| A4335 |
Incontinence supply; miscellaneous |
28,926 |
27,613 |
$124K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,192 |
3,057 |
$124K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,543 |
1,400 |
$122K |
| B4100 |
Food thickener, administered orally, per ounce |
531 |
483 |
$120K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,619 |
2,345 |
$114K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
1,740 |
1,615 |
$113K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
12,957 |
9,042 |
$106K |
| A4322 |
Irrigation syringe, bulb or piston, each |
17,395 |
15,999 |
$103K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
692 |
682 |
$102K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
844 |
813 |
$100K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
9,136 |
8,877 |
$95K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
35,888 |
15,906 |
$95K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
17,162 |
15,409 |
$93K |
| A4623 |
Tracheostomy, inner cannula |
2,046 |
1,736 |
$84K |
| E0277 |
Powered pressure-reducing air mattress |
324 |
300 |
$82K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
19,760 |
18,346 |
$78K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,538 |
1,471 |
$75K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
654 |
539 |
$74K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,119 |
1,010 |
$71K |
| E0481 |
Intrapulmonary percussive ventilation system and related accessories |
148 |
148 |
$65K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
971 |
807 |
$63K |
| A7030 |
Full face mask used with positive airway pressure device, each |
725 |
694 |
$60K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,497 |
1,364 |
$54K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,678 |
1,583 |
$52K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
354 |
342 |
$49K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
927 |
882 |
$44K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
2,792 |
2,458 |
$41K |
| E0570 |
Nebulizer, with compressor |
601 |
563 |
$39K |
| A4927 |
Gloves, non-sterile, per 100 |
7,854 |
7,429 |
$36K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,034 |
974 |
$31K |
| L1499 |
Spinal orthosis, not otherwise specified |
16 |
15 |
$31K |
| A4481 |
Tracheostoma filter, any type, any size, each |
5,189 |
4,078 |
$31K |
| E1399 |
Durable medical equipment, miscellaneous |
40 |
24 |
$29K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
1,152 |
1,116 |
$29K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
564 |
537 |
$28K |
| A7037 |
Tubing used with positive airway pressure device |
1,753 |
1,692 |
$26K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,092 |
1,043 |
$25K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
10,786 |
10,205 |
$24K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
773 |
650 |
$23K |
| A4402 |
Lubricant, per ounce |
5,830 |
5,543 |
$21K |
| A4217 |
Sterile water/saline, 500 ml |
1,314 |
1,064 |
$19K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
791 |
765 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
957 |
943 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
936 |
915 |
$15K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,317 |
1,270 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
864 |
818 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
731 |
651 |
$11K |
| K0006 |
Heavy duty wheelchair |
148 |
144 |
$10K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
260 |
231 |
$9K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
64 |
56 |
$9K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,300 |
1,017 |
$9K |
| A7525 |
Tracheostomy mask, each |
4,010 |
3,723 |
$9K |
| L8501 |
Tracheostomy speaking valve |
159 |
149 |
$9K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,214 |
1,131 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,952 |
1,858 |
$8K |
| E0776 |
Iv pole |
210 |
204 |
$7K |
| K0003 |
Lightweight wheelchair |
170 |
164 |
$7K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
91 |
88 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,340 |
3,035 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
643 |
630 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
79 |
74 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,309 |
4,052 |
$4K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
38 |
36 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
31 |
25 |
$3K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
30 |
30 |
$3K |
| A4245 |
Alcohol wipes, per box |
2,465 |
2,379 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
44 |
38 |
$2K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
3,417 |
3,309 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
323 |
310 |
$2K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
726 |
654 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
165 |
164 |
$2K |
| B4082 |
Nasogastric tubing without stylet |
26 |
25 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
28 |
28 |
$1K |
| A4456 |
Adhesive remover, wipes, any type, each |
148 |
123 |
$1K |
| A4244 |
Alcohol or peroxide, per pint |
2,010 |
1,927 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
13 |
12 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
13 |
13 |
$877.50 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
187 |
174 |
$665.23 |
| A4371 |
Ostomy skin barrier, powder, per oz |
12 |
12 |
$41.94 |
| A9270 |
Non-covered item or service |
382 |
277 |
$0.00 |