| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,198 |
1,973 |
$1.24M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,344 |
5,045 |
$1.12M |
| 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 |
2,357 |
1,691 |
$838K |
| J1559 |
Injection, immune globulin (hizentra), 100 mg |
566 |
168 |
$598K |
| 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 |
3,813 |
3,379 |
$575K |
| 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 |
2,450 |
2,114 |
$398K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
2,843 |
2,215 |
$261K |
| 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 |
2,212 |
1,768 |
$260K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
1,515 |
677 |
$259K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,334 |
503 |
$182K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,691 |
1,500 |
$129K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
5,909 |
2,648 |
$119K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,742 |
1,647 |
$108K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,065 |
989 |
$80K |
| 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 |
44 |
41 |
$23K |
| B4224 |
Parenteral nutrition administration kit, per day |
227 |
49 |
$21K |
| 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 |
231 |
206 |
$11K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
46 |
12 |
$10K |
| B4100 |
Food thickener, administered orally, per ounce |
262 |
238 |
$8K |
| 99601 |
|
69 |
51 |
$7K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
227 |
49 |
$7K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
12 |
12 |
$3K |
| S9460 |
Diabetic management program, nurse visit |
21 |
12 |
$3K |
| S9470 |
Nutritional counseling, dietitian visit |
13 |
12 |
$0.00 |