| 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 |
15,910 |
12,696 |
$587K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,413 |
3,289 |
$498K |
| 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 |
674 |
487 |
$266K |
| 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 |
1,419 |
1,046 |
$253K |
| 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 |
1,181 |
971 |
$171K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,027 |
782 |
$141K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,471 |
1,223 |
$111K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,689 |
7,191 |
$100K |
| 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 |
1,444 |
1,117 |
$93K |
| 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 |
447 |
316 |
$90K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,330 |
1,055 |
$76K |
| 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 |
911 |
735 |
$52K |
| B9998 |
Noc for enteral supplies |
1,782 |
1,127 |
$51K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,462 |
1,312 |
$47K |
| E1392 |
Portable oxygen concentrator, rental |
6,822 |
5,250 |
$29K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,493 |
1,327 |
$25K |
| A7030 |
Full face mask used with positive airway pressure device, each |
764 |
649 |
$24K |
| 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 |
363 |
265 |
$20K |
| E0570 |
Nebulizer, with compressor |
3,079 |
2,451 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,838 |
1,679 |
$15K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
939 |
817 |
$14K |
| E0776 |
Iv pole |
1,347 |
1,090 |
$9K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
742 |
591 |
$9K |
| A7035 |
Headgear used with positive airway pressure device |
792 |
658 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,582 |
2,249 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
235 |
181 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
91 |
75 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
423 |
345 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,003 |
888 |
$624.95 |
| A7037 |
Tubing used with positive airway pressure device |
142 |
120 |
$494.72 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
133 |
123 |
$368.54 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$115.71 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
61 |
52 |
$45.34 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
72 |
61 |
$34.49 |