| 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 |
35,792 |
31,038 |
$1.34M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,256 |
1,816 |
$592K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,045 |
3,037 |
$541K |
| 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 |
3,668 |
3,021 |
$322K |
| 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 |
3,035 |
1,651 |
$303K |
| 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 |
1,198 |
727 |
$297K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,442 |
1,129 |
$248K |
| 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 |
504 |
323 |
$226K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,771 |
3,890 |
$146K |
| 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 |
1,397 |
1,182 |
$132K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,837 |
4,399 |
$126K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,345 |
12,160 |
$104K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,787 |
1,562 |
$63K |
| 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 |
354 |
309 |
$57K |
| A7037 |
Tubing used with positive airway pressure device |
4,962 |
4,572 |
$56K |
| B9998 |
Noc for enteral supplies |
2,923 |
1,685 |
$46K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,451 |
4,489 |
$43K |
| B9002 |
Enteral nutrition infusion pump, any type |
788 |
720 |
$41K |
| E0570 |
Nebulizer, with compressor |
3,461 |
2,751 |
$31K |
| E1392 |
Portable oxygen concentrator, rental |
2,950 |
2,511 |
$27K |
| A7035 |
Headgear used with positive airway pressure device |
2,062 |
1,857 |
$24K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
669 |
606 |
$24K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,103 |
6,472 |
$23K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
761 |
709 |
$21K |
| K0003 |
Lightweight wheelchair |
659 |
571 |
$18K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,440 |
1,296 |
$11K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
391 |
312 |
$10K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
204 |
145 |
$7K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
371 |
364 |
$6K |
| E0776 |
Iv pole |
610 |
550 |
$5K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
667 |
600 |
$4K |
| 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 |
14 |
12 |
$4K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
25 |
24 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
310 |
271 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
217 |
188 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,102 |
1,724 |
$1K |
| K0001 |
Standard wheelchair |
145 |
118 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
209 |
190 |
$792.14 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
17 |
15 |
$491.26 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
105 |
89 |
$466.58 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
12 |
12 |
$21.45 |