| 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 |
3,962 |
2,959 |
$4.32M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,185 |
5,646 |
$1.21M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,604 |
1,494 |
$932K |
| B9002 |
Enteral nutrition infusion pump, any type |
10,981 |
10,643 |
$752K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
9,655 |
9,030 |
$713K |
| 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 |
1,576 |
1,407 |
$572K |
| 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 |
2,575 |
2,367 |
$486K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,960 |
3,532 |
$471K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,213 |
2,978 |
$429K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
2,458 |
2,283 |
$401K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
16,754 |
6,884 |
$344K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,813 |
2,625 |
$247K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,403 |
1,274 |
$220K |
| 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 |
278 |
264 |
$213K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,059 |
1,827 |
$211K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,777 |
7,236 |
$208K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
331 |
295 |
$184K |
| B9998 |
Noc for enteral supplies |
612 |
475 |
$164K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
654 |
601 |
$142K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,437 |
1,329 |
$134K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
427 |
390 |
$129K |
| A4554 |
Disposable underpads, all sizes |
3,232 |
3,083 |
$128K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,553 |
1,380 |
$116K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,676 |
1,614 |
$109K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
975 |
647 |
$83K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
1,737 |
1,562 |
$82K |
| 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 |
463 |
423 |
$78K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
194 |
182 |
$73K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
915 |
806 |
$71K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,850 |
3,543 |
$63K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,190 |
3,850 |
$59K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
855 |
807 |
$58K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,451 |
2,276 |
$58K |
| A4927 |
Gloves, non-sterile, per 100 |
5,916 |
5,498 |
$58K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
712 |
662 |
$53K |
| K0001 |
Standard wheelchair |
1,735 |
1,675 |
$52K |
| 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 |
316 |
291 |
$48K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
5,069 |
4,517 |
$48K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,150 |
1,994 |
$41K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,787 |
1,670 |
$40K |
| E0570 |
Nebulizer, with compressor |
490 |
439 |
$38K |
| 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 |
781 |
711 |
$36K |
| E0619 |
Apnea monitor, with recording feature |
321 |
268 |
$34K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,326 |
1,239 |
$33K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
658 |
611 |
$31K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,193 |
1,035 |
$28K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,964 |
1,835 |
$26K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,033 |
962 |
$25K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
241 |
226 |
$25K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,976 |
2,766 |
$24K |
| E0776 |
Iv pole |
1,723 |
1,646 |
$20K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
532 |
489 |
$17K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
157 |
142 |
$16K |
| A4332 |
Lubricant, individual sterile packet, each |
1,481 |
1,395 |
$15K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
87 |
85 |
$14K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,055 |
1,025 |
$12K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,961 |
1,873 |
$12K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
526 |
507 |
$11K |
| A4245 |
Alcohol wipes, per box |
1,409 |
1,343 |
$11K |
| A7002 |
Tubing, used with suction pump, each |
3,471 |
3,272 |
$10K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
981 |
928 |
$7K |
| A4244 |
Alcohol or peroxide, per pint |
2,172 |
1,977 |
$7K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
74 |
67 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
816 |
773 |
$5K |
| A7000 |
Canister, disposable, used with suction pump, each |
848 |
761 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
312 |
299 |
$4K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
30 |
28 |
$3K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
344 |
332 |
$3K |
| A7525 |
Tracheostomy mask, each |
813 |
758 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
12 |
12 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
513 |
342 |
$2K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
268 |
248 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
242 |
196 |
$2K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
25 |
25 |
$2K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
14 |
12 |
$890.52 |