| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,782 |
3,148 |
$6.26M |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,768 |
1,632 |
$2.45M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
4,760 |
4,492 |
$2.20M |
| E1399 |
Durable medical equipment, miscellaneous |
4,695 |
2,542 |
$1.87M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
15,784 |
14,948 |
$1.15M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,456 |
2,165 |
$405K |
| B9998 |
Noc for enteral supplies |
1,776 |
988 |
$369K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,952 |
1,722 |
$306K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,658 |
1,043 |
$207K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12,035 |
11,334 |
$156K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,872 |
1,529 |
$115K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,790 |
2,541 |
$110K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,387 |
1,289 |
$73K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,233 |
1,113 |
$69K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
1,888 |
1,686 |
$55K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,154 |
1,074 |
$55K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,620 |
1,468 |
$53K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
293 |
264 |
$51K |
| A4623 |
Tracheostomy, inner cannula |
805 |
689 |
$42K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,153 |
1,034 |
$38K |
| E0570 |
Nebulizer, with compressor |
1,677 |
1,533 |
$35K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,009 |
2,586 |
$30K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,351 |
2,973 |
$25K |
| A4927 |
Gloves, non-sterile, per 100 |
2,047 |
1,733 |
$24K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,626 |
2,278 |
$24K |
| E0601 |
Continuous positive airway pressure (cpap) device |
643 |
619 |
$23K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,457 |
1,266 |
$22K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,885 |
2,411 |
$21K |
| E1392 |
Portable oxygen concentrator, rental |
1,192 |
1,170 |
$20K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,538 |
1,381 |
$18K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
78 |
66 |
$17K |
| 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 |
49 |
45 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
3,357 |
2,912 |
$12K |
| A7505 |
Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each |
261 |
146 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
116 |
112 |
$8K |
| L8501 |
Tracheostomy speaking valve |
162 |
137 |
$7K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
41 |
39 |
$7K |
| 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 |
12 |
12 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,498 |
2,204 |
$7K |
| A4217 |
Sterile water/saline, 500 ml |
603 |
524 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
63 |
62 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,122 |
980 |
$5K |
| A4554 |
Disposable underpads, all sizes |
239 |
224 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
181 |
168 |
$3K |
| E0560 |
Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery |
635 |
550 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
152 |
145 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
17 |
13 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
41 |
41 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
88 |
87 |
$1K |
| A4332 |
Lubricant, individual sterile packet, each |
684 |
574 |
$1K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
43 |
38 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
184 |
159 |
$622.96 |
| A7525 |
Tracheostomy mask, each |
475 |
414 |
$401.34 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
347 |
331 |
$349.54 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
175 |
161 |
$315.97 |
| A4245 |
Alcohol wipes, per box |
58 |
58 |
$290.08 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
18 |
14 |
$167.54 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
32 |
25 |
$60.54 |
| A7015 |
Aerosol mask, used with dme nebulizer |
13 |
12 |
$16.91 |