| 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 |
27,955 |
27,648 |
$1.43M |
| 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 |
1,501 |
1,432 |
$1.21M |
| 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 |
2,874 |
2,506 |
$1.18M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,401 |
3,264 |
$723K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,328 |
2,253 |
$294K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,532 |
2,460 |
$260K |
| K0001 |
Standard wheelchair |
11,863 |
11,765 |
$257K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
5,237 |
5,216 |
$245K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,279 |
1,278 |
$234K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,188 |
7,056 |
$224K |
| 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 |
708 |
676 |
$212K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
21,960 |
21,664 |
$194K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,174 |
4,116 |
$182K |
| E0570 |
Nebulizer, with compressor |
5,866 |
5,684 |
$153K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
2,069 |
2,054 |
$139K |
| L4360 |
Walking boot, pneumatic and/or vacuum, 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 |
894 |
882 |
$137K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
683 |
683 |
$116K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,456 |
2,432 |
$98K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,270 |
2,217 |
$90K |
| 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 |
550 |
527 |
$86K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,387 |
1,359 |
$83K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,890 |
1,867 |
$68K |
| B9002 |
Enteral nutrition infusion pump, any type |
632 |
631 |
$61K |
| 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) |
704 |
702 |
$59K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,121 |
2,097 |
$57K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,642 |
1,623 |
$57K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
439 |
433 |
$38K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
3,149 |
3,146 |
$36K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,010 |
1,005 |
$30K |
| E0776 |
Iv pole |
1,835 |
1,829 |
$30K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,974 |
1,969 |
$30K |
| K0003 |
Lightweight wheelchair |
2,757 |
2,702 |
$28K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
983 |
952 |
$26K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,369 |
1,364 |
$25K |
| A7526 |
Tracheostomy tube collar/holder, each |
402 |
395 |
$22K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,143 |
1,115 |
$22K |
| A7035 |
Headgear used with positive airway pressure device |
2,226 |
2,181 |
$21K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
350 |
349 |
$16K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
604 |
600 |
$16K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
24 |
24 |
$13K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,976 |
1,919 |
$13K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
113 |
113 |
$11K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,071 |
1,067 |
$11K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
269 |
269 |
$11K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
902 |
885 |
$9K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
131 |
131 |
$8K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
448 |
430 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
317 |
311 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
740 |
735 |
$7K |
| A7002 |
Tubing, used with suction pump, each |
1,271 |
1,215 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
512 |
507 |
$7K |
| E0277 |
Powered pressure-reducing air mattress |
51 |
51 |
$7K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
65 |
64 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
336 |
336 |
$7K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,306 |
1,273 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,171 |
3,097 |
$6K |
| E0156 |
Seat attachment, walker |
806 |
781 |
$6K |
| K0006 |
Heavy duty wheelchair |
398 |
373 |
$6K |
| L3260 |
Surgical boot/shoe, each |
593 |
592 |
$6K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
53 |
53 |
$5K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
158 |
158 |
$5K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
276 |
208 |
$4K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
478 |
478 |
$4K |
| K0007 |
Extra heavy duty wheelchair |
68 |
66 |
$4K |
| 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 |
53 |
51 |
$4K |
| 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 |
76 |
73 |
$3K |
| 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 |
28 |
28 |
$3K |
| 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 |
220 |
219 |
$2K |
| 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 |
13 |
12 |
$2K |
| A4623 |
Tracheostomy, inner cannula |
25 |
25 |
$2K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
25 |
25 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
798 |
796 |
$1K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
199 |
198 |
$1K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
13 |
13 |
$1K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
13 |
13 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
101 |
101 |
$1K |
| E0184 |
Dry pressure mattress |
136 |
135 |
$806.72 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
315 |
315 |
$749.59 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
38 |
38 |
$543.06 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
13 |
13 |
$261.44 |
| A4615 |
Cannula, nasal |
41 |
41 |
$168.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
13 |
$84.76 |