| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,417 |
3,256 |
$716K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,484 |
5,960 |
$672K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,866 |
2,707 |
$359K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,799 |
4,553 |
$352K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,495 |
2,351 |
$252K |
| E0570 |
Nebulizer, with compressor |
2,038 |
1,842 |
$142K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,604 |
1,513 |
$121K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,906 |
1,756 |
$119K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,216 |
4,962 |
$114K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,461 |
2,327 |
$110K |
| 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 |
2,815 |
2,663 |
$76K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,967 |
3,728 |
$65K |
| A7035 |
Headgear used with positive airway pressure device |
2,659 |
2,502 |
$62K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
850 |
760 |
$55K |
| A7037 |
Tubing used with positive airway pressure device |
1,978 |
1,859 |
$49K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
448 |
436 |
$48K |
| K0004 |
High strength, lightweight wheelchair |
534 |
451 |
$41K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
304 |
294 |
$35K |
| K0002 |
Standard hemi (low seat) wheelchair |
678 |
585 |
$30K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
357 |
337 |
$26K |
| E1392 |
Portable oxygen concentrator, rental |
1,186 |
1,134 |
$25K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,000 |
1,864 |
$23K |
| 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) |
188 |
162 |
$20K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
784 |
715 |
$17K |
| K0001 |
Standard wheelchair |
630 |
559 |
$13K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
568 |
532 |
$10K |
| K0003 |
Lightweight wheelchair |
195 |
185 |
$9K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
282 |
263 |
$7K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
135 |
127 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,471 |
964 |
$6K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
638 |
553 |
$4K |
| 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 |
12 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
42 |
41 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
294 |
274 |
$367.86 |
| E0156 |
Seat attachment, walker |
20 |
16 |
$150.57 |
| K0053 |
Elevating footrests, articulating (telescoping), each |
34 |
25 |
$144.82 |