| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8699 |
Prosthetic implant, not otherwise specified |
1,787 |
1,580 |
$5.40M |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
589 |
409 |
$23K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
198 |
197 |
$13K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
296 |
277 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
541 |
540 |
$5K |
| B9002 |
Enteral nutrition infusion pump, any type |
161 |
160 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
448 |
285 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
132 |
132 |
$3K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
16 |
16 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
173 |
172 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,664 |
1,604 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
504 |
504 |
$2K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
140 |
138 |
$1K |
| K0001 |
Standard wheelchair |
415 |
414 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
283 |
282 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
303 |
303 |
$1K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
51 |
50 |
$988.94 |
| E0776 |
Iv pole |
167 |
166 |
$789.48 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
660 |
659 |
$783.00 |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
57 |
57 |
$684.54 |
| A4456 |
Adhesive remover, wipes, any type, each |
231 |
207 |
$615.00 |
| A4371 |
Ostomy skin barrier, powder, per oz |
252 |
217 |
$485.86 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
479 |
475 |
$481.84 |
| A4259 |
Lancets, per box of 100 |
1,635 |
1,578 |
$344.50 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
60 |
60 |
$271.93 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
61 |
61 |
$256.12 |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
28 |
28 |
$186.72 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
43 |
43 |
$130.92 |
| A5120 |
Skin barrier, wipes or swabs, each |
148 |
147 |
$129.75 |
| A4452 |
Tape, waterproof, per 18 square inches |
84 |
83 |
$125.00 |
| A7000 |
Canister, disposable, used with suction pump, each |
41 |
40 |
$120.75 |
| A7036 |
Chinstrap used with positive airway pressure device |
79 |
79 |
$100.56 |
| A7002 |
Tubing, used with suction pump, each |
39 |
39 |
$26.88 |
| A4927 |
Gloves, non-sterile, per 100 |
40 |
40 |
$11.90 |
| A4670 |
Automatic blood pressure monitor |
1,434 |
1,406 |
$0.00 |
| E0607 |
Home blood glucose monitor |
68 |
68 |
$0.00 |
| E0570 |
Nebulizer, with compressor |
136 |
136 |
$0.00 |
| A4258 |
Spring-powered device for lancet, each |
59 |
59 |
$0.00 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
453 |
439 |
$0.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
261 |
257 |
$0.00 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
25 |
25 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
126 |
125 |
$0.00 |
| E1399 |
Durable medical equipment, miscellaneous |
85 |
82 |
$0.00 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
124 |
119 |
$0.00 |
| 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) |
84 |
84 |
$0.00 |
| 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 |
21 |
21 |
$0.00 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
35 |
35 |
$0.00 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
23 |
21 |
$0.00 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
67 |
67 |
$0.00 |
| E1392 |
Portable oxygen concentrator, rental |
17 |
17 |
$0.00 |
| 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 |
28 |
28 |
$0.00 |
| E0156 |
Seat attachment, walker |
23 |
23 |
$0.00 |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
14 |
14 |
$0.00 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
21 |
21 |
$0.00 |
| 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 |
22 |
22 |
$0.00 |
| 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 |
29 |
29 |
$0.00 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
37 |
36 |
$0.00 |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
15 |
15 |
$0.00 |
| 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 |
22 |
21 |
$0.00 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
34 |
12 |
$0.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
77 |
76 |
$0.00 |
| A4367 |
Ostomy belt, each |
15 |
15 |
$0.00 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
77 |
74 |
$0.00 |
| K0003 |
Lightweight wheelchair |
21 |
21 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
16 |
16 |
$0.00 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
246 |
246 |
$0.00 |
| 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) |
27 |
27 |
$0.00 |