| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
827 |
756 |
$720K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,791 |
1,640 |
$465K |
| 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 |
1,412 |
950 |
$323K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,168 |
1,160 |
$317K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,642 |
2,620 |
$274K |
| B9998 |
Noc for enteral supplies |
2,530 |
2,090 |
$186K |
| 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 |
339 |
208 |
$178K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
780 |
686 |
$114K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,974 |
1,176 |
$98K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,055 |
946 |
$96K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
680 |
670 |
$85K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,966 |
1,790 |
$77K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
127 |
125 |
$72K |
| 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 |
354 |
226 |
$72K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
567 |
410 |
$59K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
368 |
331 |
$48K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,386 |
2,366 |
$47K |
| A4554 |
Disposable underpads, all sizes |
1,354 |
1,233 |
$41K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,737 |
1,577 |
$35K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
711 |
711 |
$33K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,504 |
1,455 |
$31K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
593 |
587 |
$30K |
| A7526 |
Tracheostomy tube collar/holder, each |
989 |
934 |
$29K |
| A7002 |
Tubing, used with suction pump, each |
2,186 |
1,759 |
$27K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,127 |
1,064 |
$26K |
| A4623 |
Tracheostomy, inner cannula |
325 |
316 |
$24K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,461 |
1,552 |
$21K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
904 |
900 |
$17K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
84 |
80 |
$17K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
454 |
444 |
$16K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
550 |
532 |
$10K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,747 |
1,723 |
$10K |
| A7037 |
Tubing used with positive airway pressure device |
484 |
479 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,410 |
1,386 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
1,144 |
1,129 |
$8K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,563 |
1,545 |
$7K |
| E0601 |
Continuous positive airway pressure (cpap) device |
88 |
88 |
$7K |
| A4335 |
Incontinence supply; miscellaneous |
1,299 |
1,234 |
$7K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
460 |
458 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,035 |
1,022 |
$5K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
25 |
25 |
$5K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
498 |
434 |
$5K |
| A4465 |
Non-elastic binder for extremity |
185 |
180 |
$5K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
267 |
266 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
231 |
231 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,238 |
1,226 |
$4K |
| S8301 |
Infection control supplies, not otherwise specified |
172 |
171 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
241 |
235 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
322 |
321 |
$4K |
| A4618 |
Breathing circuits |
203 |
197 |
$2K |
| K0001 |
Standard wheelchair |
87 |
83 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
504 |
488 |
$2K |
| A7525 |
Tracheostomy mask, each |
801 |
608 |
$1K |
| A4928 |
Surgical mask, per 20 |
100 |
100 |
$1K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
205 |
205 |
$1K |
| A4244 |
Alcohol or peroxide, per pint |
683 |
677 |
$1K |
| A4245 |
Alcohol wipes, per box |
212 |
205 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
721 |
702 |
$866.68 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
87 |
83 |
$848.62 |
| B9002 |
Enteral nutrition infusion pump, any type |
12 |
12 |
$802.95 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
125 |
125 |
$646.31 |
| A4332 |
Lubricant, individual sterile packet, each |
153 |
150 |
$627.24 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
469 |
466 |
$486.72 |
| A4217 |
Sterile water/saline, 500 ml |
13 |
13 |
$340.90 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$237.58 |
| A4402 |
Lubricant, per ounce |
24 |
24 |
$110.36 |
| E0776 |
Iv pole |
12 |
12 |
$65.05 |
| A4617 |
Mouth piece |
12 |
12 |
$61.80 |
| A4620 |
Variable concentration mask |
16 |
14 |
$12.81 |