| 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 |
8,912 |
7,718 |
$4.45M |
| 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 |
14,778 |
11,171 |
$2.56M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,546 |
6,162 |
$1.61M |
| B9998 |
Noc for enteral supplies |
11,128 |
8,289 |
$714K |
| 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 |
2,845 |
2,719 |
$699K |
| 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 |
2,322 |
1,910 |
$466K |
| 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 |
1,749 |
1,132 |
$431K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,027 |
2,928 |
$395K |
| 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 |
1,154 |
1,037 |
$323K |
| 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 |
1,453 |
1,391 |
$295K |
| 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 |
246 |
238 |
$284K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,621 |
2,500 |
$273K |
| B4100 |
Food thickener, administered orally, per ounce |
961 |
940 |
$227K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
957 |
940 |
$117K |
| A4554 |
Disposable underpads, all sizes |
4,616 |
4,445 |
$111K |
| E0570 |
Nebulizer, with compressor |
944 |
919 |
$96K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
869 |
858 |
$77K |
| B9002 |
Enteral nutrition infusion pump, any type |
567 |
522 |
$64K |
| A4322 |
Irrigation syringe, bulb or piston, each |
6,553 |
6,143 |
$47K |
| 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 |
84 |
77 |
$39K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
273 |
213 |
$28K |
| A4335 |
Incontinence supply; miscellaneous |
6,339 |
5,996 |
$26K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
109 |
87 |
$16K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
134 |
130 |
$13K |
| A7000 |
Canister, disposable, used with suction pump, each |
478 |
471 |
$12K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,919 |
2,772 |
$7K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
4,986 |
3,263 |
$7K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
96 |
83 |
$7K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
106 |
104 |
$4K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
68 |
64 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
604 |
592 |
$4K |
| A7002 |
Tubing, used with suction pump, each |
462 |
459 |
$4K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
58 |
57 |
$3K |
| E0776 |
Iv pole |
411 |
389 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
380 |
333 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
220 |
212 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
463 |
436 |
$1K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
85 |
80 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
12 |
12 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
880 |
836 |
$1K |
| B4081 |
Nasogastric tubing with stylet |
29 |
25 |
$1K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
36 |
36 |
$915.42 |
| A7015 |
Aerosol mask, used with dme nebulizer |
501 |
494 |
$572.20 |
| A4402 |
Lubricant, per ounce |
193 |
178 |
$512.86 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
242 |
234 |
$326.28 |