| 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 |
1,066 |
910 |
$1.12M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,831 |
2,396 |
$528K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,030 |
646 |
$512K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,981 |
8,700 |
$451K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,841 |
6,588 |
$441K |
| 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 |
856 |
742 |
$252K |
| A4554 |
Disposable underpads, all sizes |
2,658 |
2,486 |
$204K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,896 |
2,755 |
$162K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,081 |
2,001 |
$148K |
| 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 |
1,461 |
1,295 |
$140K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,203 |
2,104 |
$106K |
| A4217 |
Sterile water/saline, 500 ml |
1,233 |
1,025 |
$100K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
906 |
826 |
$85K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,245 |
1,134 |
$72K |
| 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 |
171 |
158 |
$71K |
| 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 |
648 |
595 |
$69K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,332 |
1,198 |
$66K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,127 |
3,009 |
$60K |
| B9998 |
Noc for enteral supplies |
1,441 |
1,115 |
$59K |
| A7035 |
Headgear used with positive airway pressure device |
3,620 |
3,460 |
$57K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
886 |
784 |
$57K |
| 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 |
161 |
108 |
$55K |
| A7037 |
Tubing used with positive airway pressure device |
2,722 |
2,624 |
$46K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,532 |
1,441 |
$41K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
414 |
384 |
$37K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
664 |
567 |
$35K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
355 |
342 |
$34K |
| A4927 |
Gloves, non-sterile, per 100 |
2,640 |
2,428 |
$33K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
853 |
768 |
$32K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
411 |
341 |
$32K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,834 |
1,688 |
$29K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
527 |
500 |
$29K |
| E1392 |
Portable oxygen concentrator, rental |
2,668 |
2,558 |
$28K |
| B9002 |
Enteral nutrition infusion pump, any type |
314 |
299 |
$27K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
285 |
279 |
$22K |
| E1399 |
Durable medical equipment, miscellaneous |
1,192 |
676 |
$20K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,207 |
1,074 |
$19K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,210 |
3,004 |
$16K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
110 |
110 |
$16K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
674 |
626 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
1,975 |
1,825 |
$14K |
| A4605 |
Tracheal suction catheter, closed system, each |
112 |
88 |
$12K |
| A7031 |
Face mask interface, replacement for full face mask, each |
451 |
410 |
$12K |
| A4623 |
Tracheostomy, inner cannula |
97 |
77 |
$10K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
514 |
449 |
$10K |
| E0570 |
Nebulizer, with compressor |
359 |
353 |
$10K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,685 |
1,579 |
$9K |
| 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) |
140 |
135 |
$9K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
141 |
125 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
558 |
484 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,729 |
1,564 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
105 |
103 |
$4K |
| K0001 |
Standard wheelchair |
70 |
67 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
31 |
24 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
59 |
53 |
$2K |
| A7525 |
Tracheostomy mask, each |
574 |
511 |
$2K |
| A4618 |
Breathing circuits |
106 |
82 |
$1K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
721 |
486 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
44 |
38 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
598 |
542 |
$574.13 |
| A4649 |
Surgical supply; miscellaneous |
39 |
36 |
$556.54 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
38 |
38 |
$527.75 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
113 |
86 |
$366.48 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
13 |
13 |
$235.80 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13 |
12 |
$121.80 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
27 |
25 |
$83.70 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
15 |
15 |
$73.04 |
| A7012 |
Water collection device, used with large volume nebulizer |
16 |
13 |
$59.12 |
| A4402 |
Lubricant, per ounce |
14 |
13 |
$51.03 |