| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,350 |
10,997 |
$469K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16,242 |
14,183 |
$399K |
| E0601 |
Continuous positive airway pressure (cpap) device |
9,869 |
8,630 |
$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 |
5,877 |
4,638 |
$172K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,424 |
6,532 |
$172K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,797 |
2,373 |
$148K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,260 |
3,751 |
$104K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,208 |
2,605 |
$104K |
| 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 |
1,960 |
1,434 |
$104K |
| 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 |
8,965 |
5,589 |
$103K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,955 |
2,657 |
$94K |
| K0001 |
Standard wheelchair |
7,685 |
6,653 |
$81K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,775 |
3,253 |
$81K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,535 |
3,553 |
$80K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
526 |
453 |
$75K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,199 |
2,795 |
$72K |
| A7035 |
Headgear used with positive airway pressure device |
4,354 |
3,656 |
$55K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,176 |
3,503 |
$54K |
| E0570 |
Nebulizer, with compressor |
3,051 |
2,825 |
$53K |
| K0004 |
High strength, lightweight wheelchair |
639 |
527 |
$39K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,861 |
3,232 |
$28K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,608 |
6,414 |
$28K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
194 |
185 |
$27K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,452 |
1,767 |
$25K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,314 |
1,172 |
$25K |
| E0619 |
Apnea monitor, with recording feature |
153 |
142 |
$24K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,910 |
1,822 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
1,181 |
1,003 |
$19K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,934 |
2,451 |
$19K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,159 |
846 |
$16K |
| K0003 |
Lightweight wheelchair |
1,170 |
1,018 |
$15K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
654 |
536 |
$13K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
959 |
910 |
$11K |
| 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) |
349 |
280 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,749 |
1,395 |
$8K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
381 |
349 |
$5K |
| E1392 |
Portable oxygen concentrator, rental |
1,001 |
898 |
$5K |
| K0006 |
Heavy duty wheelchair |
194 |
147 |
$5K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
172 |
147 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
135 |
72 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
267 |
263 |
$2K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
349 |
322 |
$2K |
| E0776 |
Iv pole |
1,192 |
1,156 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
224 |
224 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
28 |
27 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
269 |
265 |
$532.98 |
| K0007 |
Extra heavy duty wheelchair |
13 |
12 |
$516.06 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
20 |
12 |
$411.94 |
| E0156 |
Seat attachment, walker |
25 |
25 |
$115.01 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
15 |
14 |
$98.13 |
| A7526 |
Tracheostomy tube collar/holder, each |
19 |
12 |
$73.26 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
27 |
25 |
$43.90 |