| 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 |
17,043 |
16,485 |
$873K |
| E0601 |
Continuous positive airway pressure (cpap) device |
16,528 |
16,251 |
$725K |
| E0570 |
Nebulizer, with compressor |
17,673 |
17,070 |
$413K |
| 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 |
1,568 |
1,501 |
$287K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,818 |
3,752 |
$272K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,923 |
1,875 |
$264K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,011 |
4,941 |
$231K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,569 |
7,462 |
$180K |
| 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) |
1,843 |
1,824 |
$172K |
| A7031 |
Face mask interface, replacement for full face mask, each |
5,130 |
5,062 |
$135K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,601 |
13,212 |
$113K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,182 |
3,099 |
$111K |
| K0001 |
Standard wheelchair |
6,827 |
6,634 |
$108K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,485 |
2,396 |
$87K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,262 |
2,229 |
$85K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
882 |
846 |
$77K |
| A7035 |
Headgear used with positive airway pressure device |
6,015 |
5,921 |
$77K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
850 |
806 |
$61K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,067 |
1,030 |
$54K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,745 |
3,634 |
$53K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,750 |
1,112 |
$51K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
1,218 |
1,199 |
$46K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,488 |
1,472 |
$40K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,518 |
10,378 |
$37K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
2,982 |
2,855 |
$36K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
334 |
323 |
$26K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,651 |
1,574 |
$26K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,018 |
985 |
$25K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,191 |
3,141 |
$22K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
796 |
777 |
$19K |
| K0003 |
Lightweight wheelchair |
771 |
752 |
$18K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
980 |
948 |
$17K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
571 |
551 |
$15K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,716 |
3,616 |
$14K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
711 |
692 |
$12K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
125 |
121 |
$9K |
| E0156 |
Seat attachment, walker |
1,121 |
1,087 |
$8K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
306 |
294 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
548 |
527 |
$7K |
| K0007 |
Extra heavy duty wheelchair |
121 |
120 |
$5K |
| K0006 |
Heavy duty wheelchair |
130 |
127 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
78 |
76 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
353 |
343 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
253 |
240 |
$2K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
13 |
12 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,082 |
2,038 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
503 |
320 |
$2K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
20 |
16 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
14 |
14 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
83 |
79 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
54 |
50 |
$1K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
12 |
12 |
$1K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
32 |
28 |
$927.50 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
138 |
126 |
$894.22 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
36 |
36 |
$891.99 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
114 |
112 |
$842.71 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
498 |
489 |
$812.01 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
197 |
185 |
$702.44 |
| A4456 |
Adhesive remover, wipes, any type, each |
61 |
61 |
$492.27 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
18 |
14 |
$456.81 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
12 |
12 |
$305.24 |
| A5120 |
Skin barrier, wipes or swabs, each |
98 |
94 |
$282.07 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
68 |
65 |
$207.06 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
27 |
25 |
$151.12 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
197 |
195 |
$66.22 |