| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
230,436 |
187,554 |
$75.37M |
| E0784 |
External ambulatory infusion pump, insulin |
10,779 |
9,225 |
$32.68M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
244,901 |
213,154 |
$30.47M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
172,212 |
161,967 |
$20.86M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
58,680 |
48,398 |
$20.30M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
150,690 |
138,750 |
$19.05M |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
32,881 |
28,080 |
$14.69M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
27,263 |
21,466 |
$12.03M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
90,009 |
79,639 |
$11.91M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
77,324 |
62,558 |
$8.54M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
136,729 |
118,228 |
$7.65M |
| T4541 |
Incontinence product, disposable underpad, large, each |
254,080 |
213,471 |
$6.68M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
127,574 |
111,669 |
$6.20M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
98,430 |
86,180 |
$6.19M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
123,217 |
107,669 |
$5.81M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
77,726 |
66,644 |
$5.57M |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
141,076 |
123,176 |
$5.24M |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
58,873 |
51,121 |
$4.87M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
91,556 |
80,285 |
$4.64M |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
88,925 |
80,415 |
$4.33M |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
11,028 |
9,076 |
$4.25M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
11,532 |
9,557 |
$4.08M |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
149,546 |
134,026 |
$3.99M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
190,661 |
164,300 |
$3.71M |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
88,356 |
76,999 |
$3.69M |
| 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 |
24,112 |
17,126 |
$3.32M |
| 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 |
8,701 |
6,564 |
$3.16M |
| A4231 |
Infusion set for external insulin pump, needle type |
30,217 |
26,453 |
$2.87M |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
81,326 |
71,057 |
$2.85M |
| A7048 |
Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each |
6,318 |
4,261 |
$2.70M |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
49,826 |
43,447 |
$2.47M |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
21,320 |
17,974 |
$2.46M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
24,044 |
18,456 |
$2.24M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
47,856 |
40,408 |
$2.17M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
39,528 |
33,032 |
$2.06M |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
67,772 |
59,463 |
$2.05M |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
13,500 |
11,017 |
$1.97M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
31,815 |
27,394 |
$1.86M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
31,255 |
27,050 |
$1.75M |
| A4554 |
Disposable underpads, all sizes |
42,897 |
37,361 |
$1.73M |
| 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 |
27,418 |
22,958 |
$1.72M |
| 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 |
24,629 |
16,158 |
$1.66M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
19,258 |
15,812 |
$1.60M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
32,585 |
25,993 |
$1.52M |
| 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 |
26,541 |
18,303 |
$1.52M |
| S9435 |
Medical foods for inborn errors of metabolism |
1,920 |
1,302 |
$1.38M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
27,519 |
22,826 |
$1.30M |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
24,944 |
21,006 |
$1.29M |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
9,068 |
7,280 |
$1.26M |
| A4670 |
Automatic blood pressure monitor |
24,890 |
23,784 |
$1.23M |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
8,796 |
7,960 |
$1.22M |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
23,082 |
20,141 |
$1.21M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
20,093 |
17,507 |
$1.14M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
16,470 |
13,804 |
$1.14M |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
17,448 |
15,014 |
$1.11M |
| 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 |
10,030 |
7,200 |
$1.11M |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
50,984 |
40,507 |
$1.09M |
| A6210 |
Foam 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 |
5,341 |
4,205 |
$1.09M |
| A4927 |
Gloves, non-sterile, per 100 |
287,273 |
253,482 |
$1.07M |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,602 |
1,854 |
$1.05M |
| A4452 |
Tape, waterproof, per 18 square inches |
60,938 |
50,007 |
$1.05M |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
16,740 |
14,658 |
$1.03M |
| A5120 |
Skin barrier, wipes or swabs, each |
165,011 |
143,398 |
$994K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
8,661 |
6,478 |
$985K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
66,370 |
58,313 |
$930K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
71,234 |
63,239 |
$929K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
38,376 |
33,941 |
$827K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
14,306 |
12,276 |
$822K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
4,862 |
3,905 |
$797K |
| 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 |
4,195 |
2,528 |
$788K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
13,441 |
11,445 |
$738K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
9,436 |
7,750 |
$737K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
15,057 |
13,265 |
$736K |
| A4456 |
Adhesive remover, wipes, any type, each |
103,785 |
91,303 |
$728K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
22,900 |
20,027 |
$711K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
10,203 |
8,831 |
$699K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
5,411 |
4,639 |
$670K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
69,273 |
57,825 |
$656K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
28,754 |
21,499 |
$645K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
10,231 |
8,766 |
$596K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
6,480 |
5,575 |
$550K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
25,540 |
21,636 |
$544K |
| A4215 |
Needle, sterile, any size, each |
11,639 |
10,650 |
$522K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
6,180 |
4,984 |
$510K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
18,189 |
14,629 |
$502K |
| L9900 |
Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code |
2,617 |
1,866 |
$489K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,848 |
4,734 |
$489K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,356 |
1,107 |
$483K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
36,524 |
31,875 |
$467K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
14,777 |
12,894 |
$465K |
| 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 |
3,136 |
2,085 |
$457K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
23,783 |
19,441 |
$448K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
8,599 |
7,346 |
$428K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
13,842 |
12,167 |
$425K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
8,121 |
6,837 |
$424K |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,828 |
1,785 |
$382K |
| E1399 |
Durable medical equipment, miscellaneous |
4,153 |
3,140 |
$378K |
| A4371 |
Ostomy skin barrier, powder, per oz |
74,895 |
66,740 |
$365K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
5,461 |
4,768 |
$359K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
48,927 |
39,275 |
$355K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
4,947 |
4,198 |
$354K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,402 |
1,981 |
$321K |
| A4623 |
Tracheostomy, inner cannula |
2,818 |
2,107 |
$314K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
5,812 |
4,921 |
$310K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
993 |
741 |
$310K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50,730 |
37,705 |
$306K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
8,046 |
6,672 |
$301K |
| A4332 |
Lubricant, individual sterile packet, each |
14,770 |
12,285 |
$296K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
5,806 |
5,108 |
$296K |
| A4335 |
Incontinence supply; miscellaneous |
142,497 |
124,682 |
$280K |
| A4259 |
Lancets, per box of 100 |
50,238 |
46,299 |
$280K |
| 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 |
2,807 |
2,279 |
$270K |
| A4354 |
Insertion tray with drainage bag but without catheter |
1,966 |
1,445 |
$269K |
| A4367 |
Ostomy belt, each |
38,115 |
33,978 |
$262K |
| 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 |
865 |
581 |
$262K |
| A4649 |
Surgical supply; miscellaneous |
5,007 |
3,886 |
$254K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
3,517 |
2,942 |
$252K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
2,478 |
2,015 |
$233K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
6,782 |
5,628 |
$231K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
4,117 |
3,270 |
$229K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
3,602 |
2,946 |
$228K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
3,952 |
3,005 |
$223K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
1,228 |
976 |
$221K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
4,178 |
3,458 |
$213K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
30,408 |
25,240 |
$207K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
31,765 |
26,765 |
$205K |
| A4408 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
2,209 |
1,830 |
$204K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
7,665 |
5,885 |
$203K |
| E0570 |
Nebulizer, with compressor |
2,800 |
2,531 |
$191K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
20,546 |
16,429 |
$183K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
18,778 |
15,070 |
$176K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
5,188 |
4,627 |
$176K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
276 |
243 |
$175K |
| A6154 |
Wound pouch, each |
1,204 |
897 |
$174K |
| 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 |
4,066 |
3,412 |
$171K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
10,964 |
8,938 |
$171K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,307 |
1,814 |
$171K |
| A4245 |
Alcohol wipes, per box |
30,563 |
27,712 |
$170K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,841 |
3,109 |
$161K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,980 |
2,365 |
$160K |
| B9998 |
Noc for enteral supplies |
1,383 |
1,045 |
$159K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,351 |
3,774 |
$159K |
| A4930 |
Gloves, sterile, per pair |
5,981 |
5,038 |
$151K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,933 |
2,397 |
$151K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,978 |
2,563 |
$149K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
2,187 |
1,665 |
$140K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
6,874 |
5,205 |
$139K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
25,390 |
22,366 |
$137K |
| A6260 |
Wound cleansers, any type, any size |
16,172 |
13,661 |
$137K |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
2,732 |
2,353 |
$135K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,869 |
4,039 |
$134K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
2,785 |
2,323 |
$131K |
| A4322 |
Irrigation syringe, bulb or piston, each |
8,923 |
7,196 |
$128K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
2,412 |
2,123 |
$126K |
| B4100 |
Food thickener, administered orally, per ounce |
2,489 |
2,143 |
$126K |
| A6235 |
Hydrocolloid 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 |
826 |
669 |
$123K |
| A6198 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing |
355 |
281 |
$121K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
3,609 |
3,226 |
$121K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
2,482 |
2,074 |
$120K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
444 |
400 |
$116K |
| A4402 |
Lubricant, per ounce |
22,674 |
19,874 |
$115K |
| A4417 |
Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each |
1,220 |
963 |
$115K |
| A4392 |
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
1,608 |
1,359 |
$113K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,742 |
3,077 |
$110K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
6,193 |
4,907 |
$103K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,584 |
1,893 |
$102K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
5,606 |
4,095 |
$102K |
| A4396 |
Ostomy belt with peristomal hernia support |
3,886 |
3,494 |
$97K |
| A4217 |
Sterile water/saline, 500 ml |
6,130 |
5,313 |
$97K |
| E0607 |
Home blood glucose monitor |
2,255 |
2,051 |
$89K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
31,009 |
27,418 |
$87K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
1,028 |
852 |
$87K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
7,642 |
6,752 |
$86K |
| A5055 |
Stoma cap |
2,998 |
2,599 |
$79K |
| A4391 |
Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each |
1,102 |
919 |
$77K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
5,287 |
4,387 |
$77K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
2,531 |
2,188 |
$71K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
2,526 |
1,964 |
$68K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
815 |
617 |
$65K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,334 |
1,231 |
$65K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
3,391 |
2,647 |
$63K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
1,296 |
1,145 |
$61K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
728 |
567 |
$60K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
8,901 |
7,285 |
$59K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
3,635 |
3,052 |
$57K |
| A4433 |
Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each |
2,009 |
1,605 |
$57K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
1,710 |
1,438 |
$54K |
| A4553 |
Non-disposable underpads, all sizes |
2,012 |
1,681 |
$53K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
613 |
506 |
$50K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
268 |
220 |
$44K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
824 |
644 |
$42K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
666 |
576 |
$42K |
| A4404 |
Ostomy ring, each |
2,655 |
2,314 |
$42K |
| A4421 |
Ostomy supply; miscellaneous |
3,194 |
2,629 |
$42K |
| A5071 |
Ostomy pouch, urinary; with barrier attached (1 piece), each |
669 |
596 |
$37K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
567 |
401 |
$37K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
720 |
570 |
$36K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
4,150 |
3,765 |
$35K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
558 |
403 |
$30K |
| G0249 |
Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests |
300 |
260 |
$30K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,392 |
1,184 |
$29K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
3,026 |
2,503 |
$29K |
| A4426 |
Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each |
951 |
838 |
$29K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,490 |
1,241 |
$27K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
1,314 |
1,170 |
$27K |
| A4363 |
Ostomy clamp, any type, replacement only, each |
3,337 |
2,926 |
$25K |
| A4252 |
Blood ketone test or reagent strip, each |
118 |
106 |
$22K |
| S8490 |
Insulin syringes (100 syringes, any size) |
622 |
580 |
$22K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
1,472 |
1,221 |
$20K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
343 |
247 |
$20K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
5,574 |
4,490 |
$20K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
308 |
246 |
$20K |
| A7000 |
Canister, disposable, used with suction pump, each |
832 |
697 |
$20K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
204 |
167 |
$20K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
1,336 |
989 |
$18K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
2,967 |
2,422 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
1,226 |
1,029 |
$17K |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
654 |
556 |
$17K |
| A7030 |
Full face mask used with positive airway pressure device, each |
236 |
206 |
$16K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,273 |
1,197 |
$16K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
874 |
701 |
$14K |
| A4422 |
Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each |
1,475 |
1,231 |
$12K |
| A4398 |
Ostomy irrigation supply; bag, each |
1,210 |
1,063 |
$11K |
| A4366 |
Ostomy vent, any type, each |
1,119 |
977 |
$10K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
590 |
526 |
$9K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
3,364 |
2,896 |
$9K |
| A4399 |
Ostomy irrigation supply; cone/catheter, with or without brush |
1,204 |
1,054 |
$9K |
| A7037 |
Tubing used with positive airway pressure device |
692 |
611 |
$9K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
930 |
797 |
$9K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
55 |
54 |
$8K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
241 |
175 |
$7K |
| A9270 |
Non-covered item or service |
812 |
554 |
$7K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
415 |
327 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
176 |
152 |
$7K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
172 |
150 |
$7K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,593 |
1,462 |
$7K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
352 |
294 |
$7K |
| A5062 |
Ostomy pouch, drainable; without barrier attached (1 piece), each |
148 |
125 |
$6K |
| A4246 |
Betadine or phisohex solution, per pint |
885 |
797 |
$6K |
| A5102 |
Bedside drainage bottle with or without tubing, rigid or expandable, each |
741 |
569 |
$6K |
| A4614 |
Peak expiratory flow rate meter, hand held |
342 |
295 |
$5K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
400 |
268 |
$5K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
54 |
49 |
$5K |
| A4258 |
Spring-powered device for lancet, each |
642 |
593 |
$5K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, 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 pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
154 |
141 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,403 |
1,299 |
$4K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
115 |
115 |
$3K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
93 |
68 |
$3K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
27 |
26 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,118 |
855 |
$3K |
| E0667 |
Segmental pneumatic appliance for use with pneumatic compressor, full leg |
12 |
12 |
$3K |
| E0245 |
Tub stool or bench |
93 |
91 |
$3K |
| E0325 |
Urinal; male, jug-type, any material |
1,035 |
898 |
$3K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
62 |
52 |
$3K |
| E0244 |
Raised toilet seat |
103 |
101 |
$3K |
| A5114 |
Leg strap; foam or fabric, replacement only, per set |
609 |
476 |
$3K |
| A4397 |
Irrigation supply; sleeve, each |
172 |
153 |
$2K |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
83 |
81 |
$2K |
| K0603 |
Replacement battery for external infusion pump owned by patient, alkaline, 1.5 volt, each |
1,580 |
1,258 |
$2K |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
60 |
46 |
$2K |
| E1639 |
Scale, each |
70 |
67 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,271 |
1,186 |
$2K |
| E0215 |
Electric heat pad, moist |
61 |
55 |
$2K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
30 |
26 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
151 |
111 |
$2K |
| A4235 |
Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
500 |
474 |
$2K |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
133 |
89 |
$2K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
27 |
25 |
$2K |
| L0641 |
Lumbar orthosis, sagittal control, with rigid posterior panel(s), 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, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
29 |
29 |
$2K |
| 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 |
22 |
17 |
$1K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
79 |
71 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
91 |
83 |
$1K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
32 |
26 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
45 |
37 |
$876.68 |
| A4602 |
Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each |
57 |
53 |
$629.88 |
| A4233 |
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
318 |
277 |
$532.88 |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
18 |
17 |
$450.92 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
28 |
27 |
$323.06 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
13 |
12 |
$316.86 |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
13 |
$313.96 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
13 |
12 |
$250.14 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
35 |
26 |
$115.93 |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
30 |
24 |
$101.53 |