| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,337 |
3,784 |
$3.20M |
| 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 |
3,118 |
2,313 |
$1.45M |
| Y2032 |
|
2,844 |
2,543 |
$872K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,618 |
4,307 |
$715K |
| B9998 |
Noc for enteral supplies |
8,055 |
5,970 |
$638K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
4,144 |
1,584 |
$586K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,854 |
1,667 |
$571K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,730 |
6,223 |
$547K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,844 |
2,002 |
$484K |
| 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 |
1,621 |
1,234 |
$413K |
| 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 |
2,103 |
1,634 |
$341K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
19,103 |
4,667 |
$298K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
370 |
340 |
$246K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,032 |
924 |
$225K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,817 |
1,642 |
$188K |
| A4217 |
Sterile water/saline, 500 ml |
2,708 |
2,491 |
$170K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,015 |
4,654 |
$166K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,605 |
2,999 |
$162K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,322 |
1,158 |
$134K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,455 |
1,331 |
$134K |
| 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 |
217 |
209 |
$97K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,503 |
2,339 |
$90K |
| A4605 |
Tracheal suction catheter, closed system, each |
762 |
705 |
$78K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
705 |
646 |
$74K |
| A4930 |
Gloves, sterile, per pair |
1,618 |
1,507 |
$69K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,818 |
3,563 |
$64K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
716 |
661 |
$63K |
| A4927 |
Gloves, non-sterile, per 100 |
4,338 |
3,995 |
$61K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,478 |
3,281 |
$58K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
565 |
524 |
$47K |
| A7002 |
Tubing, used with suction pump, each |
3,319 |
3,130 |
$37K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
759 |
673 |
$36K |
| 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 |
1,014 |
876 |
$30K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
790 |
734 |
$29K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,762 |
2,609 |
$26K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
508 |
474 |
$25K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,855 |
1,740 |
$23K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,656 |
2,489 |
$22K |
| 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) |
88 |
78 |
$21K |
| 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 |
97 |
89 |
$15K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,364 |
1,276 |
$12K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
3,012 |
2,801 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,236 |
1,797 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,711 |
2,233 |
$7K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
971 |
586 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,266 |
1,199 |
$6K |
| A4402 |
Lubricant, per ounce |
1,322 |
1,236 |
$4K |
| E1399 |
Durable medical equipment, miscellaneous |
83 |
69 |
$4K |
| A7525 |
Tracheostomy mask, each |
2,298 |
934 |
$4K |
| A7012 |
Water collection device, used with large volume nebulizer |
815 |
436 |
$2K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
440 |
392 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
1,114 |
997 |
$1K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
14 |
12 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
197 |
94 |
$274.51 |
| A5120 |
Skin barrier, wipes or swabs, each |
28 |
24 |
$204.00 |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
42 |
38 |
$3.92 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
38 |
35 |
$0.00 |