| 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 |
15,620 |
15,535 |
$1.79M |
| K0001 |
Standard wheelchair |
2,212 |
2,198 |
$572K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
3,119 |
1,559 |
$504K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
20,440 |
14,990 |
$478K |
| E0570 |
Nebulizer, with compressor |
2,384 |
2,368 |
$228K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,684 |
1,834 |
$169K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,344 |
1,327 |
$129K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,339 |
2,321 |
$120K |
| 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 |
2,429 |
1,214 |
$114K |
| 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 |
1,706 |
869 |
$111K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
180 |
178 |
$79K |
| E0601 |
Continuous positive airway pressure (cpap) device |
258 |
255 |
$76K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
369 |
366 |
$74K |
| E0277 |
Powered pressure-reducing air mattress |
182 |
177 |
$60K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
340 |
334 |
$54K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
442 |
435 |
$48K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
14 |
13 |
$43K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
555 |
547 |
$40K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,072 |
2,056 |
$30K |
| 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 |
489 |
403 |
$27K |
| E0748 |
Osteogenesis stimulator, electrical, non-invasive, spinal applications |
12 |
12 |
$26K |
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on 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 |
39 |
39 |
$25K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
643 |
461 |
$20K |
| K0003 |
Lightweight wheelchair |
50 |
50 |
$18K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
311 |
306 |
$16K |
| T4541 |
Incontinence product, disposable underpad, large, each |
449 |
443 |
$12K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
13 |
13 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
110 |
107 |
$8K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
192 |
183 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
329 |
316 |
$7K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
116 |
112 |
$7K |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
79 |
79 |
$7K |
| E0305 |
Bed side rails, half length |
74 |
74 |
$6K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
42 |
30 |
$6K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
12 |
12 |
$6K |
| E0245 |
Tub stool or bench |
135 |
135 |
$5K |
| E0156 |
Seat attachment, walker |
350 |
349 |
$4K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
17 |
17 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
256 |
246 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
83 |
80 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
54 |
27 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
106 |
103 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
42 |
42 |
$2K |
| E0271 |
Mattress, innerspring |
25 |
25 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
291 |
280 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
64 |
63 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
136 |
134 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
14 |
13 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,232 |
1,227 |
$1K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
15 |
15 |
$969.24 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
41 |
41 |
$917.62 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$810.42 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
247 |
238 |
$688.08 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
14 |
14 |
$192.59 |