| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
27,416 |
25,623 |
$1.01M |
| 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 |
7,211 |
5,887 |
$613K |
| 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 |
6,573 |
5,731 |
$472K |
| 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 |
5,612 |
5,036 |
$458K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,773 |
4,181 |
$426K |
| 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 |
1,785 |
1,429 |
$345K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,146 |
2,745 |
$276K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,130 |
13,458 |
$225K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,099 |
1,991 |
$79K |
| B9998 |
Noc for enteral supplies |
923 |
756 |
$49K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,327 |
1,271 |
$47K |
| 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 |
189 |
149 |
$46K |
| 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) |
456 |
437 |
$35K |
| 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 |
43 |
36 |
$29K |
| A7030 |
Full face mask used with positive airway pressure device, each |
844 |
797 |
$28K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,076 |
1,021 |
$27K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,233 |
1,153 |
$21K |
| E0570 |
Nebulizer, with compressor |
2,110 |
1,881 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,529 |
1,457 |
$19K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
950 |
915 |
$17K |
| E1392 |
Portable oxygen concentrator, rental |
1,193 |
1,088 |
$14K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,574 |
6,266 |
$14K |
| 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 |
634 |
583 |
$12K |
| E0776 |
Iv pole |
1,822 |
1,736 |
$12K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,023 |
981 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
914 |
861 |
$11K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
238 |
222 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
295 |
265 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
431 |
405 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
380 |
349 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
409 |
390 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
43 |
38 |
$998.41 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
987 |
889 |
$932.46 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
34 |
33 |
$229.34 |