| 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 |
28,385 |
27,212 |
$2.15M |
| 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 |
2,909 |
2,610 |
$1.54M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
5,100 |
4,491 |
$1.51M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
7,259 |
6,960 |
$1.03M |
| E0601 |
Continuous positive airway pressure (cpap) device |
13,997 |
13,666 |
$851K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
1,741 |
1,666 |
$739K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,661 |
4,240 |
$692K |
| E0570 |
Nebulizer, with compressor |
12,959 |
12,428 |
$606K |
| 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 |
3,831 |
3,327 |
$566K |
| 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 |
5,431 |
4,797 |
$505K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,473 |
6,221 |
$459K |
| 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) |
3,191 |
3,050 |
$433K |
| 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 |
10,664 |
10,306 |
$406K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,296 |
4,070 |
$391K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,568 |
4,300 |
$382K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,640 |
2,536 |
$342K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12,058 |
11,703 |
$336K |
| B9998 |
Noc for enteral supplies |
3,827 |
3,088 |
$328K |
| K0001 |
Standard wheelchair |
10,218 |
9,700 |
$327K |
| 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 |
2,325 |
2,008 |
$321K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
3,039 |
2,893 |
$284K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,014 |
4,511 |
$258K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,927 |
7,611 |
$258K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,770 |
5,428 |
$251K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,213 |
2,997 |
$248K |
| 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 |
1,236 |
1,099 |
$224K |
| A7035 |
Headgear used with positive airway pressure device |
8,154 |
7,874 |
$180K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,117 |
3,986 |
$176K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,711 |
1,625 |
$168K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
857 |
848 |
$152K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,724 |
3,578 |
$152K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,161 |
4,009 |
$151K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,542 |
1,397 |
$143K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
7,451 |
7,180 |
$131K |
| A4670 |
Automatic blood pressure monitor |
2,928 |
2,850 |
$129K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
628 |
596 |
$128K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,389 |
1,271 |
$127K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,868 |
1,801 |
$114K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
252 |
250 |
$108K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,799 |
1,968 |
$107K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,701 |
4,403 |
$105K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,775 |
1,626 |
$102K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,970 |
2,741 |
$99K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,129 |
1,056 |
$98K |
| 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 |
443 |
404 |
$94K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,321 |
1,202 |
$85K |
| A4927 |
Gloves, non-sterile, per 100 |
6,959 |
6,541 |
$82K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
754 |
689 |
$77K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
943 |
867 |
$76K |
| E0245 |
Tub stool or bench |
1,893 |
1,786 |
$71K |
| A7037 |
Tubing used with positive airway pressure device |
3,330 |
3,200 |
$64K |
| K0006 |
Heavy duty wheelchair |
723 |
680 |
$61K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,136 |
1,054 |
$58K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,438 |
2,290 |
$57K |
| K0007 |
Extra heavy duty wheelchair |
368 |
336 |
$56K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
641 |
595 |
$54K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
651 |
587 |
$52K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,100 |
2,078 |
$49K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,156 |
12,817 |
$49K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
998 |
839 |
$47K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
291 |
265 |
$46K |
| E1392 |
Portable oxygen concentrator, rental |
1,557 |
1,471 |
$45K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
987 |
896 |
$41K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,828 |
2,715 |
$39K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
410 |
397 |
$38K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,490 |
1,411 |
$37K |
| 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 |
178 |
107 |
$34K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
863 |
839 |
$31K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
598 |
500 |
$31K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
4,241 |
4,083 |
$28K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,959 |
1,883 |
$28K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,031 |
838 |
$27K |
| E0244 |
Raised toilet seat |
653 |
605 |
$26K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
791 |
740 |
$25K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
306 |
289 |
$25K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
425 |
313 |
$24K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
982 |
812 |
$22K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
378 |
346 |
$22K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
280 |
257 |
$21K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
146 |
137 |
$19K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
764 |
643 |
$19K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
135 |
115 |
$15K |
| E0156 |
Seat attachment, walker |
1,374 |
1,322 |
$14K |
| A4623 |
Tracheostomy, inner cannula |
218 |
196 |
$12K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
324 |
282 |
$11K |
| 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 |
175 |
159 |
$11K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,609 |
4,408 |
$10K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,151 |
1,096 |
$9K |
| E0776 |
Iv pole |
489 |
469 |
$9K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
409 |
372 |
$9K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
84 |
74 |
$8K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
391 |
337 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
919 |
779 |
$7K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
828 |
749 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,093 |
993 |
$7K |
| A7036 |
Chinstrap used with positive airway pressure device |
709 |
694 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
745 |
678 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
983 |
892 |
$6K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
122 |
115 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,241 |
3,073 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
130 |
121 |
$5K |
| B4100 |
Food thickener, administered orally, per ounce |
26 |
26 |
$5K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
580 |
494 |
$5K |
| A4452 |
Tape, waterproof, per 18 square inches |
194 |
167 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
736 |
652 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
642 |
574 |
$4K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
27 |
27 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
451 |
434 |
$4K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
66 |
66 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
546 |
377 |
$3K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
31 |
24 |
$3K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
28 |
27 |
$3K |
| 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) |
12 |
12 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
29 |
28 |
$2K |
| A7526 |
Tracheostomy tube collar/holder, each |
117 |
109 |
$2K |
| A4402 |
Lubricant, per ounce |
785 |
728 |
$2K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
25 |
25 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
142 |
88 |
$2K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
68 |
55 |
$2K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
42 |
37 |
$2K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
21 |
16 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
149 |
138 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
176 |
164 |
$1K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
15 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
159 |
146 |
$1K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
13 |
13 |
$815.60 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
27 |
27 |
$763.45 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$673.49 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
14 |
12 |
$665.34 |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$542.03 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
14 |
12 |
$395.31 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$349.85 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
197 |
65 |
$311.90 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
25 |
24 |
$142.54 |
| A4259 |
Lancets, per box of 100 |
26 |
24 |
$42.70 |