| 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 |
1,015 |
840 |
$386K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,749 |
1,532 |
$192K |
| E0601 |
Continuous positive airway pressure (cpap) device |
61,427 |
59,718 |
$187K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
63,522 |
61,640 |
$184K |
| E1392 |
Portable oxygen concentrator, rental |
6,622 |
5,957 |
$159K |
| E0607 |
Home blood glucose monitor |
1,907 |
1,665 |
$131K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
48,848 |
47,717 |
$107K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,812 |
5,334 |
$103K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,854 |
2,487 |
$86K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
934 |
673 |
$79K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,098 |
4,641 |
$63K |
| S9494 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules s9497-s9504) |
460 |
239 |
$56K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
20,571 |
20,104 |
$50K |
| 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) |
8,050 |
7,784 |
$46K |
| K0001 |
Standard wheelchair |
44,909 |
43,769 |
$43K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,893 |
1,739 |
$39K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,678 |
1,488 |
$35K |
| A7037 |
Tubing used with positive airway pressure device |
9,590 |
8,769 |
$33K |
| 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 |
752 |
667 |
$32K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,923 |
2,356 |
$31K |
| A7035 |
Headgear used with positive airway pressure device |
5,426 |
4,798 |
$27K |
| 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 |
854 |
768 |
$25K |
| 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) |
5,160 |
5,082 |
$24K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
7,293 |
7,094 |
$20K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,140 |
1,049 |
$18K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
1,093 |
1,040 |
$18K |
| A7526 |
Tracheostomy tube collar/holder, each |
983 |
877 |
$16K |
| E0277 |
Powered pressure-reducing air mattress |
1,042 |
1,009 |
$15K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
744 |
661 |
$15K |
| 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 |
13 |
12 |
$14K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,102 |
2,832 |
$14K |
| 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 |
1,152 |
1,048 |
$13K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
5,739 |
4,732 |
$12K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,075 |
940 |
$12K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
747 |
665 |
$11K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
756 |
636 |
$11K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
2,615 |
2,576 |
$10K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
866 |
785 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,927 |
8,040 |
$9K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
1,472 |
1,363 |
$8K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
874 |
769 |
$8K |
| E0776 |
Iv pole |
6,143 |
5,989 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
6,103 |
5,597 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
18,213 |
17,648 |
$7K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,906 |
5,765 |
$7K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
7,966 |
7,736 |
$7K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,009 |
951 |
$6K |
| K0006 |
Heavy duty wheelchair |
2,298 |
2,245 |
$6K |
| A4618 |
Breathing circuits |
861 |
757 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
5,863 |
5,731 |
$5K |
| E0156 |
Seat attachment, walker |
523 |
447 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
302 |
264 |
$4K |
| K0003 |
Lightweight wheelchair |
1,072 |
1,032 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
15,037 |
14,757 |
$4K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,706 |
1,511 |
$4K |
| A7002 |
Tubing, used with suction pump, each |
4,261 |
2,153 |
$3K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
301 |
260 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,034 |
919 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,177 |
2,130 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
408 |
301 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
160 |
133 |
$2K |
| E0935 |
Continuous passive motion exercise device for use on knee only |
28 |
19 |
$2K |
| B9998 |
Noc for enteral supplies |
42 |
24 |
$2K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,091 |
3,053 |
$1K |
| A4259 |
Lancets, per box of 100 |
5,549 |
4,591 |
$1K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
537 |
536 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,535 |
1,400 |
$1K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
239 |
204 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
405 |
380 |
$1K |
| A4367 |
Ostomy belt, each |
746 |
675 |
$1K |
| E0570 |
Nebulizer, with compressor |
6,252 |
6,155 |
$766.00 |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
1,204 |
1,182 |
$677.24 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
477 |
433 |
$543.96 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
551 |
542 |
$242.20 |
| A4456 |
Adhesive remover, wipes, any type, each |
1,207 |
1,101 |
$145.55 |
| A4452 |
Tape, waterproof, per 18 square inches |
1,040 |
947 |
$110.20 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
115 |
105 |
$104.28 |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
194 |
194 |
$85.10 |
| K0007 |
Extra heavy duty wheelchair |
623 |
620 |
$56.59 |
| A5120 |
Skin barrier, wipes or swabs, each |
846 |
757 |
$40.71 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
12 |
12 |
$39.88 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
193 |
193 |
$17.46 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
427 |
390 |
$6.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
123 |
98 |
$5.40 |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
19 |
19 |
$0.00 |
| K0010 |
Standard - weight frame motorized/power wheelchair |
15 |
15 |
$0.00 |
| E0272 |
Mattress, foam rubber |
12 |
12 |
$0.00 |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
50 |
47 |
$0.00 |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,347 |
1,306 |
$0.00 |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
86 |
37 |
$0.00 |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
66 |
66 |
$0.00 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
21 |
21 |
$0.00 |
| 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 |
13 |
12 |
$0.00 |
| E2367 |
Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each |
22 |
22 |
$0.00 |