1629355482

1629355482 was paid $10.30M by Medicaid between Jan 2018 and Aug 2022, across 30 billing codes. Its largest line is 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 — 26% of everything it billed.

33Billing provider info1629355482

33aNPI1629355482

33bProvider type—

28Total paid$10.30M

24GClaims80,376

24DCodes billed30

24AFirst – last monthJan 2018 – Aug 2022

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	23,936	$2.93M
2019	16,753	$2.26M
2020	15,879	$2.05M
2021	16,026	$2.03M
2022	7,782	$1.02M

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	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	26%	3,349	2,461	$2.66M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	13%	13,762	7,438	$1.37M
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	11%	4,320	3,411	$1.13M
B9998	Noc for enteral supplies	6.5%	7,478	6,000	$666K
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	6.3%	2,083	1,533	$645K
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	6.0%	7,934	2,176	$617K
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	5.7%	1,750	1,163	$587K
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	5.0%	1,222	791	$512K
S9342	Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem	4.6%	2,017	1,104	$474K
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	4.4%	4,826	3,589	$449K
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	3.3%	4,356	2,963	$344K
B4034	Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	2.3%	5,479	3,376	$237K

18 more codes

B9002	Enteral nutrition infusion pump, any type	1.2%	2,116	$120K
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)	<1%	10,611	$93K
B4185	Parenteral nutrition solution, not otherwise specified, 10 grams lipids	<1%	1,376	$78K
A4222	Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)	<1%	1,146	$63K
B4224	Parenteral nutrition administration kit, per day	<1%	1,368	$49K
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	<1%	1,334	$36K
B4088	Gastrostomy/jejunostomy tube, low-profile, any material, any type, each	<1%	628	$30K
A4305	Disposable drug delivery system, flow rate of 50 ml or greater per hour	<1%	322	$27K
B4220	Parenteral nutrition supply kit; premix, per day	<1%	1,410	$23K
99601		<1%	176	$20K
S9343	Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem	<1%	64	$18K
E0776	Iv pole	<1%	324	$18K
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	<1%	121	$14K
S9500	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem	<1%	73	$7K
E0781	Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient	<1%	15	$1K
K0552	Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each	<1%	218	$910.42
A4211	Supplies for self-administered injections	<1%	465	$328.64
J7050	Infusion, normal saline solution, 250 cc	<1%	33	$82.60

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.