| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
4,915 |
4,190 |
$1.83M |
| 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 |
2,703 |
2,188 |
$1.74M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,356 |
6,789 |
$1.59M |
| 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 |
2,307 |
1,962 |
$705K |
| B4224 |
Parenteral nutrition administration kit, per day |
8,702 |
2,153 |
$703K |
| 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 |
4,193 |
3,395 |
$654K |
| 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 |
1,071 |
879 |
$597K |
| 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 |
3,765 |
3,134 |
$448K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,655 |
2,369 |
$369K |
| B9998 |
Noc for enteral supplies |
4,732 |
4,186 |
$329K |
| 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 |
1,015 |
865 |
$315K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
13,745 |
4,488 |
$314K |
| 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 |
1,111 |
911 |
$191K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,150 |
1,721 |
$174K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,944 |
2,656 |
$139K |
| 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 |
892 |
776 |
$105K |
| B9004 |
Parenteral nutrition infusion pump, portable |
993 |
606 |
$78K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
646 |
512 |
$67K |
| A4211 |
Supplies for self-administered injections |
852 |
274 |
$52K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
471 |
397 |
$49K |
| B4100 |
Food thickener, administered orally, per ounce |
390 |
341 |
$31K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
1,216 |
341 |
$25K |
| E0776 |
Iv pole |
317 |
258 |
$19K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
335 |
129 |
$4K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
165 |
74 |
$2K |
| E0779 |
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
881 |
39 |
$1K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
690 |
173 |
$1K |