| 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 |
34,920 |
32,543 |
$1.57M |
| 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 |
3,119 |
2,267 |
$614K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
901 |
823 |
$348K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,824 |
2,476 |
$264K |
| 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 |
2,517 |
2,092 |
$242K |
| 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 |
917 |
640 |
$232K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,640 |
13,697 |
$194K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,146 |
4,838 |
$192K |
| 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 |
2,247 |
1,808 |
$156K |
| 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 |
1,416 |
1,164 |
$133K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,072 |
1,894 |
$83K |
| E1392 |
Portable oxygen concentrator, rental |
4,115 |
3,803 |
$69K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,595 |
2,374 |
$65K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,428 |
2,257 |
$59K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,190 |
1,961 |
$46K |
| E0570 |
Nebulizer, with compressor |
3,473 |
3,128 |
$38K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
877 |
792 |
$37K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,800 |
1,645 |
$34K |
| A7035 |
Headgear used with positive airway pressure device |
2,797 |
2,540 |
$33K |
| B9998 |
Noc for enteral supplies |
457 |
388 |
$29K |
| A7037 |
Tubing used with positive airway pressure device |
3,399 |
3,123 |
$28K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,311 |
8,566 |
$23K |
| B9002 |
Enteral nutrition infusion pump, any type |
456 |
425 |
$19K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
662 |
608 |
$13K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
573 |
536 |
$12K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
721 |
658 |
$6K |
| 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) |
81 |
75 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,304 |
1,171 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
130 |
95 |
$4K |
| 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 |
77 |
43 |
$3K |
| K0001 |
Standard wheelchair |
82 |
74 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
348 |
321 |
$1K |
| E0776 |
Iv pole |
154 |
150 |
$577.66 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
437 |
373 |
$437.49 |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
12 |
12 |
$239.99 |