| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,264 |
1,379 |
$388K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,234 |
7,733 |
$233K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,210 |
6,727 |
$149K |
| K0003 |
Lightweight wheelchair |
4,458 |
4,202 |
$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 |
735 |
714 |
$57K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,464 |
1,294 |
$43K |
| K0001 |
Standard wheelchair |
3,796 |
3,362 |
$39K |
| A4623 |
Tracheostomy, inner cannula |
1,441 |
1,304 |
$39K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,268 |
1,204 |
$37K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,489 |
1,311 |
$36K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,944 |
1,829 |
$33K |
| 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 |
946 |
891 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,734 |
7,223 |
$28K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,412 |
1,334 |
$28K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,032 |
914 |
$26K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,067 |
1,025 |
$22K |
| K0006 |
Heavy duty wheelchair |
850 |
803 |
$16K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,751 |
2,515 |
$16K |
| K0007 |
Extra heavy duty wheelchair |
648 |
594 |
$16K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,462 |
2,150 |
$15K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,202 |
1,056 |
$15K |
| 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 |
122 |
113 |
$13K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
770 |
679 |
$13K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,262 |
1,166 |
$11K |
| E0570 |
Nebulizer, with compressor |
4,038 |
3,929 |
$10K |
| 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 |
184 |
173 |
$9K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,371 |
1,302 |
$7K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
218 |
183 |
$7K |
| A7526 |
Tracheostomy tube collar/holder, each |
548 |
483 |
$5K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
782 |
680 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
278 |
133 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,314 |
1,216 |
$4K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,148 |
1,043 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
229 |
212 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,033 |
796 |
$2K |
| 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) |
50 |
48 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
1,859 |
1,308 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
118 |
107 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
41 |
39 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
461 |
447 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
121 |
116 |
$946.62 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
664 |
591 |
$940.36 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
194 |
175 |
$651.92 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
68 |
63 |
$340.03 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
277 |
255 |
$303.74 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
14 |
12 |
$177.12 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$99.84 |
| E0776 |
Iv pole |
18 |
16 |
$75.11 |