| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
14,685 |
9,897 |
$8.38M |
| 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 |
11,643 |
7,820 |
$6.26M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
33,043 |
20,998 |
$3.73M |
| B9998 |
Noc for enteral supplies |
57,096 |
22,496 |
$2.70M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
33,843 |
30,825 |
$2.64M |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
10,591 |
7,437 |
$2.63M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,871 |
3,320 |
$2.60M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
6,780 |
5,908 |
$2.01M |
| 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 |
7,577 |
4,875 |
$1.80M |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
10,361 |
4,880 |
$1.78M |
| 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 |
11,310 |
8,017 |
$1.77M |
| Y2032 |
|
5,541 |
4,968 |
$1.69M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
50,062 |
18,742 |
$1.69M |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
12,245 |
7,983 |
$1.64M |
| 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 |
2,682 |
1,558 |
$954K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
28,421 |
25,428 |
$871K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
9,180 |
7,110 |
$786K |
| A4217 |
Sterile water/saline, 500 ml |
14,654 |
10,385 |
$783K |
| 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) |
2,985 |
2,611 |
$712K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
8,494 |
6,210 |
$692K |
| A7526 |
Tracheostomy tube collar/holder, each |
15,907 |
11,393 |
$680K |
| A4605 |
Tracheal suction catheter, closed system, each |
5,638 |
4,136 |
$590K |
| E1399 |
Durable medical equipment, miscellaneous |
2,319 |
658 |
$558K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,767 |
4,672 |
$536K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
6,434 |
1,471 |
$528K |
| T4541 |
Incontinence product, disposable underpad, large, each |
13,553 |
11,350 |
$450K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
830 |
702 |
$425K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,636 |
4,591 |
$419K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
951 |
888 |
$395K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,105 |
1,811 |
$362K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22,219 |
15,666 |
$300K |
| A4927 |
Gloves, non-sterile, per 100 |
23,789 |
18,587 |
$296K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,155 |
2,609 |
$290K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,443 |
3,561 |
$288K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,938 |
1,648 |
$284K |
| A4930 |
Gloves, sterile, per pair |
7,781 |
5,902 |
$283K |
| A7000 |
Canister, disposable, used with suction pump, each |
19,619 |
15,017 |
$282K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
4,843 |
3,631 |
$266K |
| 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 |
2,315 |
1,762 |
$264K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,888 |
2,522 |
$225K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,576 |
3,380 |
$219K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,718 |
2,125 |
$211K |
| 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 |
1,722 |
1,062 |
$196K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,124 |
2,864 |
$189K |
| A7002 |
Tubing, used with suction pump, each |
20,328 |
15,003 |
$189K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
967 |
763 |
$182K |
| K0001 |
Standard wheelchair |
4,774 |
4,496 |
$179K |
| 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 |
5,512 |
3,613 |
$178K |
| 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 |
947 |
495 |
$168K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,430 |
1,226 |
$154K |
| A4322 |
Irrigation syringe, bulb or piston, each |
17,435 |
13,015 |
$132K |
| 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 |
824 |
603 |
$112K |
| A4452 |
Tape, waterproof, per 18 square inches |
9,995 |
7,687 |
$108K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
974 |
850 |
$101K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,120 |
982 |
$100K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
2,031 |
1,883 |
$99K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,885 |
2,394 |
$98K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,677 |
1,238 |
$92K |
| E0570 |
Nebulizer, with compressor |
1,535 |
1,393 |
$92K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
724 |
540 |
$88K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
380 |
315 |
$83K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
748 |
538 |
$81K |
| K0005 |
Ultralightweight wheelchair |
80 |
60 |
$74K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
8,813 |
6,692 |
$73K |
| K0003 |
Lightweight wheelchair |
629 |
583 |
$71K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
21,902 |
10,531 |
$68K |
| B4100 |
Food thickener, administered orally, per ounce |
1,304 |
791 |
$61K |
| 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 |
400 |
263 |
$58K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
829 |
649 |
$57K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
558 |
460 |
$56K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,744 |
1,326 |
$55K |
| K0006 |
Heavy duty wheelchair |
578 |
530 |
$53K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
576 |
512 |
$53K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
17,230 |
13,456 |
$51K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
6,335 |
5,185 |
$43K |
| E0776 |
Iv pole |
1,021 |
825 |
$39K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
6,199 |
3,131 |
$39K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,429 |
10,330 |
$38K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
3,953 |
482 |
$36K |
| L8501 |
Tracheostomy speaking valve |
670 |
465 |
$33K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
7,021 |
5,343 |
$31K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
975 |
708 |
$29K |
| A7035 |
Headgear used with positive airway pressure device |
1,002 |
917 |
$25K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
601 |
499 |
$24K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
9,087 |
6,575 |
$23K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
395 |
299 |
$22K |
| A7525 |
Tracheostomy mask, each |
10,176 |
4,619 |
$22K |
| K0040 |
Adjustable angle footplate, each |
204 |
152 |
$19K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
645 |
490 |
$19K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
221 |
202 |
$19K |
| A4402 |
Lubricant, per ounce |
7,360 |
5,629 |
$18K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
465 |
447 |
$16K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
280 |
210 |
$16K |
| A7012 |
Water collection device, used with large volume nebulizer |
5,628 |
2,905 |
$16K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
213 |
158 |
$15K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
287 |
200 |
$14K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,705 |
806 |
$14K |
| B4082 |
Nasogastric tubing without stylet |
950 |
376 |
$13K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,204 |
788 |
$12K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
61 |
50 |
$11K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
210 |
133 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
5,266 |
2,588 |
$11K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,568 |
1,562 |
$10K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,050 |
824 |
$10K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
444 |
389 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
384 |
361 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
192 |
161 |
$8K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
228 |
169 |
$7K |
| A4244 |
Alcohol or peroxide, per pint |
6,556 |
4,804 |
$7K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
19 |
12 |
$7K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
56 |
50 |
$5K |
| A4670 |
Automatic blood pressure monitor |
114 |
113 |
$5K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
65 |
58 |
$5K |
| A7030 |
Full face mask used with positive airway pressure device, each |
60 |
53 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
955 |
326 |
$3K |
| E0156 |
Seat attachment, walker |
310 |
297 |
$3K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
13 |
13 |
$3K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
30 |
25 |
$2K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
15 |
12 |
$2K |
| E0245 |
Tub stool or bench |
49 |
48 |
$2K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
24 |
24 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
57 |
55 |
$791.94 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
81 |
53 |
$581.76 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
12 |
12 |
$522.61 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
360 |
204 |
$471.49 |
| B4081 |
Nasogastric tubing with stylet |
39 |
26 |
$411.90 |
| K0038 |
Leg strap, each |
14 |
13 |
$304.09 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
128 |
116 |
$278.58 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
13 |
13 |
$124.31 |
| A4616 |
Tubing (oxygen), per foot |
569 |
377 |
$84.17 |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
1,354 |
1,001 |
$80.04 |
| A4615 |
Cannula, nasal |
48 |
45 |
$0.00 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
157 |
123 |
$0.00 |