| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
6,109 |
4,599 |
$2.35M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18,584 |
15,639 |
$901K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,907 |
1,399 |
$743K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,116 |
2,472 |
$525K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
8,996 |
6,935 |
$451K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
6,121 |
4,597 |
$367K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,022 |
1,574 |
$327K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
6,460 |
4,940 |
$324K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
5,058 |
4,287 |
$309K |
| A7526 |
Tracheostomy tube collar/holder, each |
9,097 |
6,761 |
$263K |
| 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 |
1,804 |
1,286 |
$254K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
18,889 |
7,174 |
$224K |
| A4217 |
Sterile water/saline, 500 ml |
4,765 |
3,360 |
$191K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
16,034 |
13,498 |
$189K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
11,461 |
9,072 |
$146K |
| A4605 |
Tracheal suction catheter, closed system, each |
3,290 |
2,555 |
$138K |
| A7000 |
Canister, disposable, used with suction pump, each |
13,026 |
10,328 |
$125K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
5,916 |
5,048 |
$112K |
| 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 |
216 |
172 |
$107K |
| A4623 |
Tracheostomy, inner cannula |
2,787 |
1,920 |
$105K |
| A7002 |
Tubing, used with suction pump, each |
13,557 |
10,646 |
$101K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,591 |
1,312 |
$82K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
6,854 |
5,000 |
$74K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,832 |
1,503 |
$46K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,639 |
1,378 |
$37K |
| A7030 |
Full face mask used with positive airway pressure device, each |
668 |
528 |
$33K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,683 |
2,936 |
$29K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,039 |
2,420 |
$25K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
968 |
821 |
$24K |
| E0570 |
Nebulizer, with compressor |
4,111 |
3,545 |
$23K |
| 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) |
184 |
140 |
$19K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
882 |
645 |
$17K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
641 |
571 |
$15K |
| A7037 |
Tubing used with positive airway pressure device |
1,597 |
1,346 |
$13K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
736 |
532 |
$12K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
6,930 |
5,136 |
$12K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,907 |
2,230 |
$11K |
| E0776 |
Iv pole |
1,250 |
1,042 |
$9K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,952 |
2,258 |
$9K |
| A4402 |
Lubricant, per ounce |
2,608 |
2,036 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
672 |
547 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,034 |
2,544 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
464 |
311 |
$6K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
170 |
157 |
$6K |
| K0001 |
Standard wheelchair |
888 |
460 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
650 |
562 |
$4K |
| A4618 |
Breathing circuits |
647 |
457 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,553 |
2,702 |
$3K |
| A7525 |
Tracheostomy mask, each |
2,627 |
2,113 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
908 |
702 |
$3K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
243 |
202 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
210 |
182 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
232 |
186 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
18 |
12 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,268 |
1,150 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
30 |
24 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
271 |
206 |
$1K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
89 |
82 |
$782.91 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
235 |
109 |
$686.71 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
13 |
13 |
$377.75 |