| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
4,369 |
3,515 |
$3.98M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,653 |
8,920 |
$1.54M |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
26,036 |
10,965 |
$1.46M |
| B9002 |
Enteral nutrition infusion pump, any type |
15,257 |
14,609 |
$1.06M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,795 |
1,687 |
$896K |
| 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 |
4,664 |
4,294 |
$722K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
9,769 |
9,360 |
$712K |
| 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 |
2,620 |
2,285 |
$652K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
5,273 |
4,532 |
$393K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,103 |
2,911 |
$357K |
| 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 |
553 |
502 |
$340K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,502 |
4,134 |
$318K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,834 |
1,722 |
$293K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,900 |
1,847 |
$285K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,817 |
2,529 |
$281K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,855 |
7,475 |
$226K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,958 |
2,667 |
$210K |
| A4554 |
Disposable underpads, all sizes |
4,999 |
4,800 |
$168K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,040 |
824 |
$155K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,780 |
1,659 |
$151K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,854 |
3,557 |
$127K |
| B9998 |
Noc for enteral supplies |
411 |
369 |
$120K |
| A7002 |
Tubing, used with suction pump, each |
4,521 |
4,295 |
$104K |
| A4927 |
Gloves, non-sterile, per 100 |
8,412 |
7,729 |
$104K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,570 |
1,435 |
$102K |
| 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) |
312 |
299 |
$85K |
| 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 |
673 |
634 |
$83K |
| 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 |
1,515 |
1,422 |
$82K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
478 |
442 |
$81K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,179 |
3,961 |
$80K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
2,312 |
2,099 |
$79K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,921 |
5,357 |
$68K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
7,050 |
6,432 |
$68K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,970 |
3,717 |
$64K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,763 |
2,580 |
$64K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,044 |
1,011 |
$61K |
| E0619 |
Apnea monitor, with recording feature |
571 |
390 |
$60K |
| E0776 |
Iv pole |
2,735 |
2,614 |
$60K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
2,034 |
1,946 |
$56K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,264 |
2,857 |
$53K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
112 |
105 |
$53K |
| 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 |
358 |
325 |
$51K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,133 |
1,052 |
$51K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
448 |
371 |
$50K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,010 |
956 |
$46K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
300 |
273 |
$39K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
364 |
342 |
$37K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
587 |
563 |
$36K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
154 |
140 |
$36K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
614 |
520 |
$34K |
| A4245 |
Alcohol wipes, per box |
1,914 |
1,829 |
$30K |
| K0001 |
Standard wheelchair |
943 |
899 |
$28K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,352 |
1,284 |
$27K |
| E0570 |
Nebulizer, with compressor |
251 |
224 |
$26K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,029 |
1,947 |
$25K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,106 |
956 |
$25K |
| A4217 |
Sterile water/saline, 500 ml |
866 |
808 |
$23K |
| A7525 |
Tracheostomy mask, each |
1,312 |
1,236 |
$20K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,225 |
1,150 |
$20K |
| A4332 |
Lubricant, individual sterile packet, each |
1,775 |
1,596 |
$18K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
191 |
174 |
$17K |
| A4244 |
Alcohol or peroxide, per pint |
3,178 |
2,948 |
$15K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,526 |
1,442 |
$14K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
1,028 |
997 |
$14K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
1,512 |
1,471 |
$14K |
| A7012 |
Water collection device, used with large volume nebulizer |
854 |
677 |
$12K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
118 |
106 |
$10K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,125 |
1,029 |
$9K |
| 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) |
75 |
73 |
$8K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
317 |
317 |
$7K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
115 |
110 |
$5K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
720 |
663 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
547 |
463 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
13 |
12 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
15 |
13 |
$1K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
14 |
14 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
27 |
24 |
$1K |
| A4402 |
Lubricant, per ounce |
245 |
233 |
$397.97 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$127.06 |