| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
440 |
371 |
$218K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
963 |
878 |
$204K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
1,320 |
813 |
$107K |
| 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 |
432 |
250 |
$98K |
| 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 |
521 |
348 |
$54K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
395 |
349 |
$45K |
| 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 |
195 |
148 |
$31K |
| 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 |
66 |
50 |
$29K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
105 |
25 |
$14K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
180 |
170 |
$13K |
| 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 |
93 |
68 |
$11K |
| 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 |
34 |
29 |
$11K |
| B4224 |
Parenteral nutrition administration kit, per day |
106 |
27 |
$10K |
| B9998 |
Noc for enteral supplies |
56 |
52 |
$9K |
| 97803 |
|
162 |
135 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
104 |
104 |
$7K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
31 |
15 |
$5K |
| B9002 |
Enteral nutrition infusion pump, any type |
68 |
66 |
$5K |
| 97802 |
|
65 |
65 |
$4K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
103 |
27 |
$3K |
| 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 |
52 |
42 |
$3K |
| 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 |
36 |
34 |
$3K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
22 |
18 |
$2K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
34 |
16 |
$619.20 |