| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2030 |
Assisted living, waiver; per month |
9,615 |
8,622 |
$13.64M |
| T2031 |
Assisted living; waiver, per diem |
2,505 |
2,289 |
$4.01M |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
10,803 |
8,355 |
$973K |
| E1392 |
Portable oxygen concentrator, rental |
5,674 |
4,438 |
$678K |
| A0427 |
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
662 |
604 |
$178K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
10,638 |
8,603 |
$167K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,986 |
1,706 |
$163K |
| T2033 |
Residential care, not otherwise specified (nos), waiver; per diem |
137 |
113 |
$161K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,617 |
2,112 |
$136K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,745 |
1,585 |
$134K |
| 11719 |
|
5,134 |
2,939 |
$103K |
| E0277 |
Powered pressure-reducing air mattress |
1,165 |
862 |
$80K |
| A0428 |
Ambulance service, basic life support, non-emergency transport, (bls) |
288 |
245 |
$39K |
| A0425 |
Ground mileage, per statute mile |
1,904 |
1,613 |
$37K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
1,040 |
850 |
$32K |
| 84443 |
Thyroid stimulating hormone (TSH) |
1,747 |
1,717 |
$25K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
920 |
899 |
$24K |
| 80053 |
Comprehensive metabolic panel |
2,502 |
2,426 |
$21K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
163 |
160 |
$18K |
| D9410 |
|
186 |
153 |
$18K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
3,014 |
2,865 |
$18K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
2,036 |
2,016 |
$16K |
| P9604 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge |
232 |
195 |
$15K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
187 |
85 |
$14K |
| 11721 |
|
310 |
297 |
$12K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
928 |
543 |
$12K |
| 98960 |
|
290 |
173 |
$12K |
| 80061 |
Lipid panel |
900 |
885 |
$10K |
| 82607 |
|
787 |
770 |
$10K |
| K0001 |
Standard wheelchair |
1,800 |
1,450 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
110 |
107 |
$8K |
| A4615 |
Cannula, nasal |
1,539 |
870 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
520 |
430 |
$8K |
| 86480 |
|
103 |
89 |
$8K |
| V2744 |
Tint, photochromatic, per lens |
76 |
74 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
79 |
75 |
$7K |
| K0045 |
Footrest, complete assembly, replacement only, each |
824 |
687 |
$7K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
1,035 |
959 |
$7K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
156 |
145 |
$7K |
| V2020 |
Frames, purchases |
99 |
94 |
$6K |
| V5160 |
Dispensing fee, binaural |
26 |
24 |
$6K |
| V2781 |
Progressive lens, per lens |
36 |
35 |
$5K |
| V5299 |
Hearing service, miscellaneous |
318 |
284 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
234 |
223 |
$4K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
89 |
87 |
$4K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
158 |
74 |
$4K |
| E0570 |
Nebulizer, with compressor |
325 |
309 |
$4K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
597 |
565 |
$4K |
| 92015 |
Determination of refractive state |
52 |
51 |
$3K |
| 92591 |
|
42 |
37 |
$3K |
| S5162 |
Emergency response system; purchase only |
21 |
17 |
$3K |
| R0070 |
Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen |
316 |
284 |
$2K |
| G0471 |
Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) |
428 |
349 |
$2K |
| 92700 |
|
228 |
187 |
$2K |
| 87186 |
|
365 |
351 |
$2K |
| E1353 |
Regulator |
835 |
649 |
$2K |
| 87088 |
|
381 |
368 |
$2K |
| 82746 |
|
109 |
104 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
46 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
613 |
428 |
$1K |
| V5011 |
Fitting/orientation/checking of hearing aid |
42 |
37 |
$1K |
| E1354 |
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only, each |
606 |
428 |
$1K |
| 81001 |
|
360 |
342 |
$950.60 |
| 84439 |
|
285 |
285 |
$880.20 |
| P9603 |
Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled |
158 |
124 |
$875.87 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21 |
12 |
$788.34 |
| 11720 |
|
12 |
12 |
$720.00 |
| 82570 |
|
156 |
154 |
$634.00 |
| 92250 |
|
12 |
12 |
$489.72 |
| Q0092 |
Set-up portable x-ray equipment |
347 |
308 |
$488.17 |
| D0460 |
|
13 |
12 |
$342.03 |
| 83540 |
|
40 |
38 |
$325.13 |
| 36415 |
Collection of venous blood by venipuncture |
74 |
54 |
$240.36 |
| 83735 |
|
122 |
122 |
$237.80 |
| 82043 |
|
39 |
39 |
$191.16 |
| 83550 |
|
13 |
12 |
$139.23 |
| 87077 |
|
45 |
45 |
$112.84 |
| A4616 |
Tubing (oxygen), per foot |
16 |
14 |
$80.00 |
| 98941 |
Chiropractic manipulative treatment; spinal, 3-4 regions |
40 |
24 |
$0.00 |
| 85027 |
|
26 |
25 |
$0.00 |
| 86803 |
|
12 |
12 |
$0.00 |
| A0130 |
Non-emergency transportation: wheelchair van |
38 |
25 |
$0.00 |
| 71046 |
Radiologic examination, chest; 2 views |
57 |
31 |
$0.00 |
| V5267 |
Hearing aid or assistive listening device/supplies/accessories, not otherwise specified |
26 |
24 |
$0.00 |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
51 |
26 |
$0.00 |