| 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 |
5,839 |
4,050 |
$332K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
796 |
659 |
$115K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
485 |
241 |
$50K |
| 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 |
2,196 |
1,877 |
$46K |
| 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 |
274 |
154 |
$27K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
265 |
223 |
$26K |
| A4554 |
Disposable underpads, all sizes |
436 |
395 |
$22K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
816 |
643 |
$22K |
| A4623 |
Tracheostomy, inner cannula |
179 |
136 |
$20K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
13 |
12 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
700 |
589 |
$11K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
216 |
122 |
$11K |
| A7526 |
Tracheostomy tube collar/holder, each |
420 |
338 |
$10K |
| E0601 |
Continuous positive airway pressure (cpap) device |
282 |
225 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
535 |
509 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
502 |
424 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
93 |
74 |
$6K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
141 |
127 |
$6K |
| K0003 |
Lightweight wheelchair |
134 |
111 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
35 |
25 |
$5K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
105 |
100 |
$3K |
| K0001 |
Standard wheelchair |
313 |
286 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
143 |
125 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
459 |
388 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
15 |
14 |
$2K |
| E0570 |
Nebulizer, with compressor |
247 |
245 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
210 |
206 |
$1K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
207 |
169 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
365 |
272 |
$712.96 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
13 |
12 |
$513.94 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
276 |
242 |
$500.34 |
| K0004 |
High strength, lightweight wheelchair |
28 |
25 |
$184.42 |
| A7031 |
Face mask interface, replacement for full face mask, each |
19 |
12 |
$172.36 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
30 |
25 |
$159.82 |
| A7525 |
Tracheostomy mask, each |
276 |
196 |
$159.08 |