| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
19,751 |
14,958 |
$8.20M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,456 |
2,889 |
$2.21M |
| 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 |
6,972 |
6,127 |
$530K |
| 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 |
3,769 |
3,296 |
$466K |
| A4554 |
Disposable underpads, all sizes |
11,958 |
11,021 |
$457K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,750 |
4,440 |
$353K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,029 |
1,374 |
$283K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,059 |
2,809 |
$198K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,062 |
5,299 |
$194K |
| A4623 |
Tracheostomy, inner cannula |
2,604 |
1,723 |
$184K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,533 |
1,104 |
$181K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,274 |
2,103 |
$150K |
| A4927 |
Gloves, non-sterile, per 100 |
6,007 |
5,478 |
$115K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,126 |
1,558 |
$106K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,068 |
715 |
$93K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
588 |
567 |
$75K |
| A4217 |
Sterile water/saline, 500 ml |
2,099 |
1,315 |
$58K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,280 |
830 |
$57K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
73 |
54 |
$45K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
1,579 |
1,363 |
$45K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
581 |
351 |
$44K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,720 |
1,933 |
$43K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,093 |
1,469 |
$31K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
352 |
311 |
$29K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,029 |
1,553 |
$17K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
135 |
114 |
$13K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
506 |
328 |
$10K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,046 |
729 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
1,615 |
1,255 |
$4K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
175 |
121 |
$4K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
26 |
24 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
425 |
322 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
437 |
314 |
$691.54 |
| 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 |
17 |
12 |
$370.55 |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
51 |
27 |
$355.32 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
28 |
24 |
$93.51 |
| A7525 |
Tracheostomy mask, each |
19 |
12 |
$57.34 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
20 |
12 |
$6.70 |