| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
23,069 |
21,092 |
$697K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,873 |
1,759 |
$556K |
| 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 |
3,229 |
2,445 |
$222K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12,443 |
11,366 |
$120K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,466 |
3,254 |
$113K |
| 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 |
1,217 |
952 |
$106K |
| 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 |
1,550 |
1,222 |
$83K |
| 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) |
1,209 |
1,124 |
$83K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,168 |
2,043 |
$74K |
| 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 |
1,012 |
790 |
$71K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,046 |
846 |
$70K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,471 |
2,240 |
$47K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,464 |
2,279 |
$40K |
| E0570 |
Nebulizer, with compressor |
3,431 |
3,030 |
$36K |
| A7035 |
Headgear used with positive airway pressure device |
2,230 |
2,067 |
$24K |
| A7037 |
Tubing used with positive airway pressure device |
3,164 |
2,945 |
$23K |
| 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 |
84 |
55 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,217 |
7,747 |
$16K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
772 |
718 |
$12K |
| E1392 |
Portable oxygen concentrator, rental |
1,506 |
1,410 |
$11K |
| K0001 |
Standard wheelchair |
815 |
740 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
378 |
348 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
531 |
482 |
$7K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
319 |
310 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
166 |
159 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
746 |
701 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
103 |
92 |
$796.81 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
101 |
89 |
$751.44 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
12 |
$410.41 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
473 |
396 |
$332.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
20 |
16 |
$6.39 |