| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13,424 |
11,393 |
$2.15M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
41,056 |
37,734 |
$1.37M |
| 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 |
2,362 |
2,166 |
$1.19M |
| 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 |
5,265 |
4,809 |
$880K |
| B9002 |
Enteral nutrition infusion pump, any type |
6,115 |
5,331 |
$617K |
| 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 |
1,631 |
1,362 |
$510K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,204 |
13,101 |
$397K |
| 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 |
4,404 |
3,764 |
$393K |
| 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 |
9,909 |
9,179 |
$340K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,938 |
1,771 |
$337K |
| 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 |
3,173 |
2,746 |
$309K |
| E0601 |
Continuous positive airway pressure (cpap) device |
10,736 |
9,730 |
$218K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,682 |
2,848 |
$170K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,501 |
3,333 |
$156K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,510 |
2,235 |
$156K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,683 |
6,290 |
$120K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,056 |
3,816 |
$96K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,710 |
1,499 |
$79K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,513 |
2,371 |
$64K |
| 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 |
207 |
170 |
$63K |
| 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 |
126 |
120 |
$61K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,440 |
2,265 |
$50K |
| 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) |
496 |
458 |
$48K |
| A7035 |
Headgear used with positive airway pressure device |
4,379 |
4,153 |
$44K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
10,780 |
10,093 |
$43K |
| E0776 |
Iv pole |
3,384 |
3,260 |
$38K |
| E0570 |
Nebulizer, with compressor |
8,842 |
8,358 |
$36K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,478 |
1,391 |
$32K |
| A7037 |
Tubing used with positive airway pressure device |
2,603 |
2,502 |
$32K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,527 |
3,284 |
$31K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
740 |
565 |
$28K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,040 |
963 |
$26K |
| 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 |
179 |
152 |
$24K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
231 |
220 |
$24K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,383 |
1,293 |
$23K |
| K0001 |
Standard wheelchair |
2,770 |
2,552 |
$21K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,835 |
2,688 |
$17K |
| E1392 |
Portable oxygen concentrator, rental |
1,885 |
1,777 |
$14K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
367 |
340 |
$14K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
97 |
66 |
$13K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
196 |
156 |
$13K |
| B4100 |
Food thickener, administered orally, per ounce |
95 |
91 |
$12K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
832 |
793 |
$12K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
22 |
12 |
$11K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,251 |
2,162 |
$9K |
| K0003 |
Lightweight wheelchair |
1,013 |
888 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,628 |
1,454 |
$8K |
| A7526 |
Tracheostomy tube collar/holder, each |
174 |
143 |
$6K |
| B9998 |
Noc for enteral supplies |
238 |
187 |
$6K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
296 |
255 |
$5K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
397 |
387 |
$4K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
319 |
263 |
$3K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
33 |
24 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
195 |
191 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
515 |
498 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,837 |
1,678 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
238 |
229 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
32 |
25 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
379 |
237 |
$1K |
| 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 |
29 |
24 |
$901.35 |
| K0007 |
Extra heavy duty wheelchair |
42 |
39 |
$880.49 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
72 |
41 |
$741.84 |
| K0002 |
Standard hemi (low seat) wheelchair |
91 |
89 |
$636.76 |
| A7002 |
Tubing, used with suction pump, each |
482 |
340 |
$554.32 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
615 |
561 |
$520.03 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
181 |
152 |
$479.96 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
127 |
105 |
$421.94 |
| Z0020 |
|
53 |
52 |
$201.60 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
67 |
54 |
$139.81 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
391 |
371 |
$90.70 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
99 |
97 |
$83.34 |
| E0156 |
Seat attachment, walker |
14 |
12 |
$66.54 |
| E0310 |
Bed side rails, full length |
137 |
132 |
$56.75 |
| E0305 |
Bed side rails, half length |
154 |
150 |
$38.54 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
47 |
12 |
$22.96 |