| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,649 |
1,611 |
$735K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,604 |
9,508 |
$697K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,779 |
5,747 |
$312K |
| 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 |
2,002 |
1,972 |
$264K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
749 |
495 |
$196K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,158 |
3,115 |
$194K |
| E0570 |
Nebulizer, with compressor |
4,387 |
4,310 |
$150K |
| K0001 |
Standard wheelchair |
5,017 |
4,978 |
$149K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,450 |
7,383 |
$115K |
| 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 |
649 |
603 |
$71K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,190 |
6,151 |
$69K |
| 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) |
454 |
452 |
$61K |
| A4623 |
Tracheostomy, inner cannula |
961 |
912 |
$55K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
511 |
478 |
$54K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
814 |
804 |
$50K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,438 |
1,382 |
$41K |
| A4927 |
Gloves, non-sterile, per 100 |
1,708 |
1,643 |
$34K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,619 |
1,576 |
$33K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
406 |
387 |
$32K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
655 |
640 |
$27K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
699 |
683 |
$26K |
| A7030 |
Full face mask used with positive airway pressure device, each |
391 |
390 |
$26K |
| A7035 |
Headgear used with positive airway pressure device |
1,202 |
1,187 |
$23K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
368 |
341 |
$20K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,337 |
1,333 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
680 |
671 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,473 |
1,444 |
$13K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,201 |
2,173 |
$12K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
720 |
701 |
$10K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
541 |
517 |
$10K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,680 |
1,637 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,775 |
1,706 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
269 |
266 |
$8K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
55 |
54 |
$8K |
| K0004 |
High strength, lightweight wheelchair |
101 |
99 |
$7K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
211 |
211 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
867 |
857 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
1,937 |
1,842 |
$6K |
| K0007 |
Extra heavy duty wheelchair |
108 |
101 |
$5K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
106 |
105 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
82 |
81 |
$5K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
92 |
91 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,377 |
1,318 |
$3K |
| E0156 |
Seat attachment, walker |
237 |
230 |
$3K |
| K0003 |
Lightweight wheelchair |
65 |
65 |
$2K |
| A4670 |
Automatic blood pressure monitor |
44 |
44 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
25 |
25 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
149 |
106 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
194 |
188 |
$2K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
156 |
155 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
372 |
210 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
109 |
108 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,658 |
1,606 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
363 |
358 |
$2K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
129 |
120 |
$2K |
| K0006 |
Heavy duty wheelchair |
39 |
37 |
$2K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
68 |
68 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
215 |
208 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
52 |
50 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
753 |
520 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
209 |
206 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
607 |
601 |
$992.54 |
| E0776 |
Iv pole |
184 |
181 |
$915.05 |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
98 |
98 |
$857.85 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
12 |
$496.32 |
| A7036 |
Chinstrap used with positive airway pressure device |
44 |
43 |
$426.62 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
24 |
24 |
$392.90 |
| A7012 |
Water collection device, used with large volume nebulizer |
117 |
114 |
$298.18 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
117 |
113 |
$286.08 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$262.49 |
| A4259 |
Lancets, per box of 100 |
13 |
13 |
$91.58 |
| A7525 |
Tracheostomy mask, each |
17 |
15 |
$19.99 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
14 |
13 |
$0.36 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
24 |
24 |
$0.00 |