| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
18,382 |
14,059 |
$30.35M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
14,658 |
13,406 |
$7.33M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
36,891 |
28,428 |
$6.64M |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
3,785 |
3,630 |
$6.25M |
| 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 |
8,994 |
8,104 |
$4.31M |
| E1399 |
Durable medical equipment, miscellaneous |
25,243 |
17,298 |
$3.23M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
28,611 |
26,946 |
$2.82M |
| 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 |
8,915 |
8,159 |
$2.13M |
| B9998 |
Noc for enteral supplies |
10,363 |
8,797 |
$1.44M |
| B9002 |
Enteral nutrition infusion pump, any type |
23,318 |
22,357 |
$1.42M |
| 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 |
2,226 |
2,021 |
$1.39M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
36,365 |
13,324 |
$1.32M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
7,198 |
6,536 |
$1.25M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
10,619 |
9,488 |
$650K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,283 |
2,180 |
$562K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,838 |
5,513 |
$553K |
| A7526 |
Tracheostomy tube collar/holder, each |
10,268 |
9,082 |
$471K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,695 |
2,504 |
$452K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
24,287 |
23,202 |
$432K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,641 |
3,284 |
$410K |
| 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 |
2,753 |
2,523 |
$391K |
| 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 |
1,670 |
1,561 |
$362K |
| A4605 |
Tracheal suction catheter, closed system, each |
3,826 |
3,453 |
$361K |
| A4927 |
Gloves, non-sterile, per 100 |
14,379 |
12,322 |
$327K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
5,879 |
5,144 |
$320K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,153 |
1,018 |
$226K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
6,320 |
5,992 |
$184K |
| 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 |
1,100 |
966 |
$179K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
12,758 |
11,435 |
$177K |
| A7000 |
Canister, disposable, used with suction pump, each |
17,237 |
15,338 |
$174K |
| 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 |
1,088 |
1,006 |
$168K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,784 |
1,622 |
$142K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,605 |
1,416 |
$132K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
653 |
553 |
$119K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
3,665 |
3,342 |
$112K |
| 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) |
407 |
401 |
$103K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
3,700 |
3,206 |
$99K |
| A4554 |
Disposable underpads, all sizes |
5,194 |
4,801 |
$95K |
| L8501 |
Tracheostomy speaking valve |
1,713 |
1,602 |
$92K |
| 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 |
3,112 |
2,880 |
$92K |
| E0570 |
Nebulizer, with compressor |
2,508 |
2,305 |
$92K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
680 |
606 |
$90K |
| A4623 |
Tracheostomy, inner cannula |
1,510 |
1,297 |
$86K |
| A7002 |
Tubing, used with suction pump, each |
15,982 |
14,542 |
$82K |
| E0776 |
Iv pole |
1,070 |
993 |
$63K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
567 |
494 |
$58K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
587 |
530 |
$58K |
| A4649 |
Surgical supply; miscellaneous |
557 |
465 |
$54K |
| 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 |
261 |
236 |
$53K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,805 |
4,415 |
$46K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
5,789 |
5,223 |
$44K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
695 |
578 |
$42K |
| S8999 |
Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
753 |
663 |
$40K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
11,944 |
10,768 |
$38K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
326 |
266 |
$37K |
| E0601 |
Continuous positive airway pressure (cpap) device |
573 |
553 |
$32K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
269 |
257 |
$30K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,296 |
2,944 |
$29K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
277 |
227 |
$29K |
| B4082 |
Nasogastric tubing without stylet |
843 |
722 |
$26K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
343 |
327 |
$23K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,945 |
3,560 |
$19K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
248 |
236 |
$14K |
| A4402 |
Lubricant, per ounce |
4,962 |
4,396 |
$14K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,078 |
1,016 |
$14K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
806 |
788 |
$13K |
| E1392 |
Portable oxygen concentrator, rental |
599 |
572 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
238 |
230 |
$11K |
| E0619 |
Apnea monitor, with recording feature |
77 |
72 |
$10K |
| A4245 |
Alcohol wipes, per box |
3,638 |
3,135 |
$7K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,459 |
1,279 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
279 |
270 |
$5K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
810 |
759 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,642 |
3,406 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
202 |
197 |
$4K |
| B4081 |
Nasogastric tubing with stylet |
147 |
118 |
$4K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,031 |
907 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,259 |
2,090 |
$3K |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
444 |
297 |
$2K |
| A7525 |
Tracheostomy mask, each |
958 |
834 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
103 |
85 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
158 |
150 |
$943.08 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
64 |
62 |
$745.37 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
86 |
74 |
$646.64 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
252 |
216 |
$551.22 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
150 |
141 |
$414.24 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
479 |
444 |
$231.86 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
15 |
15 |
$164.56 |
| A4618 |
Breathing circuits |
27 |
25 |
$124.76 |
| A4452 |
Tape, waterproof, per 18 square inches |
26 |
25 |
$116.81 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
15 |
12 |
$111.91 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$99.22 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
12 |
12 |
$60.67 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
12 |
12 |
$0.00 |