| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
62,467 |
45,662 |
$3.53M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
33,873 |
31,089 |
$2.85M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
15,911 |
13,888 |
$2.80M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
35,227 |
32,813 |
$2.80M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
31,082 |
28,907 |
$2.72M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
43,489 |
40,439 |
$2.41M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
19,912 |
18,498 |
$2.13M |
| E0601 |
Continuous positive airway pressure (cpap) device |
42,087 |
39,412 |
$1.84M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,217 |
1,977 |
$1.74M |
| S8121 |
Oxygen contents, liquid, 1 unit equals 1 pound |
13,687 |
3,780 |
$1.24M |
| T4541 |
Incontinence product, disposable underpad, large, each |
32,563 |
29,992 |
$1.21M |
| A7030 |
Full face mask used with positive airway pressure device, each |
11,607 |
10,806 |
$1.18M |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
5,667 |
5,060 |
$1.05M |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
4,029 |
2,849 |
$1.03M |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
23,120 |
21,475 |
$938K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
13,371 |
12,454 |
$877K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
16,484 |
9,252 |
$816K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
10,902 |
9,667 |
$804K |
| E0570 |
Nebulizer, with compressor |
20,589 |
19,644 |
$797K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
6,968 |
5,974 |
$627K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,660 |
4,284 |
$580K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
3,940 |
1,466 |
$580K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
2,920 |
1,804 |
$576K |
| A7031 |
Face mask interface, replacement for full face mask, each |
12,503 |
10,638 |
$552K |
| A7035 |
Headgear used with positive airway pressure device |
22,417 |
21,011 |
$503K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
406 |
376 |
$462K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
1,443 |
906 |
$458K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,216 |
2,022 |
$455K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
747 |
712 |
$443K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,457 |
2,067 |
$434K |
| E0700 |
Safety equipment, device or accessory, any type |
5,650 |
5,474 |
$428K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
675 |
367 |
$408K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
2,052 |
1,911 |
$405K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
5,086 |
4,706 |
$402K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
1,990 |
1,374 |
$393K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
6,787 |
4,119 |
$384K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
9,549 |
8,148 |
$376K |
| 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) |
3,664 |
3,430 |
$368K |
| A4927 |
Gloves, non-sterile, per 100 |
16,223 |
14,715 |
$353K |
| E1399 |
Durable medical equipment, miscellaneous |
2,251 |
1,582 |
$336K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
6,889 |
5,980 |
$326K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
7,454 |
7,086 |
$318K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
16,711 |
12,226 |
$318K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,821 |
2,599 |
$308K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
5,912 |
5,175 |
$297K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,748 |
2,583 |
$291K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,762 |
1,571 |
$288K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
10,726 |
9,376 |
$288K |
| E1392 |
Portable oxygen concentrator, rental |
8,946 |
8,277 |
$281K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,987 |
1,798 |
$273K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,232 |
2,752 |
$273K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
3,860 |
2,061 |
$254K |
| A4670 |
Automatic blood pressure monitor |
3,822 |
3,636 |
$248K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
5,514 |
5,287 |
$239K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
1,043 |
925 |
$233K |
| K0001 |
Standard wheelchair |
10,476 |
9,445 |
$229K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,543 |
1,241 |
$225K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,317 |
1,287 |
$220K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,077 |
1,805 |
$218K |
| L2280 |
Addition to lower extremity, molded inner boot |
572 |
313 |
$214K |
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
427 |
419 |
$196K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
4,393 |
3,549 |
$190K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,484 |
3,913 |
$188K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
39,769 |
35,071 |
$182K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,380 |
5,805 |
$176K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
4,019 |
3,809 |
$163K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,292 |
1,104 |
$163K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
12,518 |
11,789 |
$159K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
2,589 |
2,418 |
$158K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
3,387 |
3,025 |
$158K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
7,026 |
6,288 |
$154K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,888 |
9,177 |
$154K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
2,409 |
2,059 |
$148K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,255 |
1,113 |
$148K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
525 |
475 |
$147K |
| E0245 |
Tub stool or bench |
1,501 |
1,414 |
$146K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
54 |
54 |
$146K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
3,366 |
3,121 |
$145K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
3,226 |
2,874 |
$143K |
| E0745 |
Neuromuscular stimulator, electronic shock unit |
1,529 |
1,417 |
$135K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,536 |
2,566 |
$126K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
2,408 |
2,245 |
$125K |
| 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) |
519 |
493 |
$124K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
1,616 |
1,097 |
$108K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
6,360 |
3,073 |
$107K |
| E2510 |
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
26 |
26 |
$102K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
2,917 |
2,676 |
$98K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
552 |
476 |
$98K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
197 |
109 |
$89K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,748 |
1,549 |
$85K |
| K0003 |
Lightweight wheelchair |
1,980 |
1,816 |
$80K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
703 |
578 |
$75K |
| S8120 |
Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
634 |
420 |
$74K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
150 |
129 |
$74K |
| A7037 |
Tubing used with positive airway pressure device |
3,626 |
3,387 |
$68K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
178 |
142 |
$67K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
134 |
86 |
$67K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
363 |
270 |
$66K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
853 |
502 |
$62K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,079 |
612 |
$58K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,640 |
1,429 |
$57K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
344 |
281 |
$56K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,437 |
1,318 |
$55K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
1,588 |
1,252 |
$52K |
| A4217 |
Sterile water/saline, 500 ml |
1,462 |
1,039 |
$51K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
127 |
76 |
$50K |
| E0627 |
Seat lift mechanism, electric, any type |
217 |
202 |
$50K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
5,918 |
2,907 |
$48K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
863 |
778 |
$48K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
299 |
268 |
$44K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,923 |
2,502 |
$42K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,666 |
1,373 |
$42K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
715 |
630 |
$42K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
733 |
695 |
$41K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
5,015 |
4,560 |
$40K |
| E0203 |
Therapeutic lightbox, minimum 10,000 lux, table top model |
282 |
270 |
$40K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
713 |
615 |
$38K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
88 |
49 |
$38K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,009 |
2,721 |
$37K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,263 |
1,031 |
$37K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
300 |
273 |
$35K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
506 |
382 |
$33K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
90 |
83 |
$31K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
270 |
249 |
$30K |
| E0244 |
Raised toilet seat |
664 |
612 |
$30K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
471 |
315 |
$29K |
| E0156 |
Seat attachment, walker |
2,102 |
1,925 |
$28K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,449 |
1,373 |
$27K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
153 |
149 |
$24K |
| A4565 |
Slings |
3,050 |
2,805 |
$24K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,871 |
2,570 |
$23K |
| L3260 |
Surgical boot/shoe, each |
2,600 |
2,413 |
$23K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
454 |
332 |
$21K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
347 |
319 |
$21K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
925 |
870 |
$21K |
| A7015 |
Aerosol mask, used with dme nebulizer |
13,968 |
11,644 |
$20K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,920 |
1,563 |
$20K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,290 |
1,102 |
$20K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,022 |
1,761 |
$19K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
488 |
452 |
$18K |
| K0007 |
Extra heavy duty wheelchair |
182 |
167 |
$18K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,559 |
2,322 |
$18K |
| A4284 |
Breast shield and splash protector for use with breast pump, replacement |
1,561 |
1,182 |
$17K |
| 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 |
300 |
235 |
$17K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,434 |
1,904 |
$17K |
| 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 |
211 |
154 |
$17K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
95 |
93 |
$16K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,190 |
1,041 |
$16K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
301 |
277 |
$16K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
346 |
191 |
$14K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,170 |
1,032 |
$13K |
| K0006 |
Heavy duty wheelchair |
229 |
188 |
$12K |
| E0155 |
Wheel attachment, rigid pick-up walker, per pair |
596 |
570 |
$12K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
12 |
12 |
$12K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,389 |
1,221 |
$12K |
| 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 |
102 |
82 |
$11K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
167 |
147 |
$10K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
96 |
50 |
$9K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
175 |
173 |
$9K |
| K0002 |
Standard hemi (low seat) wheelchair |
217 |
178 |
$9K |
| A7036 |
Chinstrap used with positive airway pressure device |
872 |
832 |
$9K |
| G0249 |
Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests |
355 |
308 |
$8K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
173 |
169 |
$8K |
| A4231 |
Infusion set for external insulin pump, needle type |
60 |
58 |
$8K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
29 |
24 |
$8K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
218 |
171 |
$7K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
445 |
313 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,231 |
1,011 |
$7K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
74 |
67 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,066 |
2,851 |
$6K |
| A4281 |
Tubing for breast pump, replacement |
826 |
759 |
$6K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
38 |
28 |
$6K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
79 |
75 |
$5K |
| K0903 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
105 |
70 |
$5K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
230 |
210 |
$5K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
84 |
38 |
$4K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
96 |
89 |
$4K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
51 |
51 |
$4K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
62 |
50 |
$4K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
17 |
12 |
$4K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
314 |
300 |
$4K |
| E0184 |
Dry pressure mattress |
169 |
161 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
58 |
51 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
331 |
286 |
$2K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
71 |
65 |
$2K |
| K0040 |
Adjustable angle footplate, each |
46 |
25 |
$2K |
| A4282 |
Adapter for breast pump, replacement |
254 |
227 |
$2K |
| A4402 |
Lubricant, per ounce |
241 |
205 |
$2K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
158 |
118 |
$2K |
| B9998 |
Noc for enteral supplies |
64 |
38 |
$2K |
| E1810 |
Dynamic adjustable knee extension and flexion device, includes soft interface material |
15 |
12 |
$2K |
| E0849 |
Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible |
13 |
12 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
163 |
145 |
$2K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
15 |
12 |
$1K |
| A4322 |
Irrigation syringe, bulb or piston, each |
30 |
25 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
12 |
$1K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
24 |
12 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
12 |
12 |
$1K |
| A4367 |
Ostomy belt, each |
109 |
100 |
$1K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
14 |
12 |
$1K |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
14 |
14 |
$1K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
71 |
64 |
$1K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
55 |
37 |
$1K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
89 |
63 |
$963.70 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
43 |
39 |
$928.48 |
| A4332 |
Lubricant, individual sterile packet, each |
72 |
62 |
$864.66 |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$841.38 |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
58 |
57 |
$562.74 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
18 |
12 |
$518.00 |
| A4245 |
Alcohol wipes, per box |
90 |
80 |
$423.06 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
17 |
12 |
$414.78 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
14 |
12 |
$376.38 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
27 |
25 |
$348.62 |
| A9270 |
Non-covered item or service |
706 |
635 |
$281.12 |
| E0776 |
Iv pole |
16 |
12 |
$178.60 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
64 |
28 |
$176.63 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
120 |
110 |
$127.57 |
| A6260 |
Wound cleansers, any type, any size |
26 |
24 |
$7.56 |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
608 |
482 |
$0.00 |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
737 |
716 |
$0.00 |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
18 |
12 |
$0.00 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
20 |
18 |
$0.00 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
13 |
13 |
$0.00 |
| E0147 |
Walker, heavy duty, multiple braking system, variable wheel resistance |
12 |
12 |
$0.00 |
| 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 |
14 |
13 |
$0.00 |
| A4657 |
Syringe, with or without needle, each |
18 |
15 |
$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 |
17 |
14 |
$0.00 |