| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
351 |
351 |
$289K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,181 |
2,176 |
$163K |
| K0001 |
Standard wheelchair |
3,477 |
3,450 |
$73K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
981 |
975 |
$41K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,175 |
1,165 |
$27K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,795 |
1,791 |
$26K |
| E0570 |
Nebulizer, with compressor |
819 |
799 |
$20K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
710 |
693 |
$20K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
559 |
557 |
$15K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
523 |
319 |
$14K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
181 |
173 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
618 |
612 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
458 |
458 |
$5K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
142 |
142 |
$5K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
25 |
25 |
$4K |
| A7000 |
Canister, disposable, used with suction pump, each |
213 |
177 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
131 |
72 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
49 |
49 |
$1K |
| A7526 |
Tracheostomy tube collar/holder, each |
24 |
24 |
$895.62 |
| A7035 |
Headgear used with positive airway pressure device |
80 |
80 |
$885.97 |
| A7002 |
Tubing, used with suction pump, each |
176 |
176 |
$792.26 |
| K0003 |
Lightweight wheelchair |
24 |
24 |
$527.44 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
110 |
110 |
$213.81 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
13 |
$68.98 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
14 |
13 |
$49.28 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
27 |
24 |
$45.58 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
13 |
$6.71 |