| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,045 |
667 |
$68K |
| A4927 |
Gloves, non-sterile, per 100 |
1,926 |
1,846 |
$32K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,273 |
741 |
$29K |
| E0601 |
Continuous positive airway pressure (cpap) device |
852 |
633 |
$24K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,058 |
1,590 |
$11K |
| K0001 |
Standard wheelchair |
4,030 |
1,579 |
$11K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
710 |
261 |
$5K |
| E0570 |
Nebulizer, with compressor |
4,912 |
1,865 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,110 |
555 |
$5K |
| 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 |
46 |
38 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
636 |
222 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
747 |
579 |
$2K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
199 |
69 |
$726.01 |
| A4259 |
Lancets, per box of 100 |
962 |
497 |
$489.96 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
861 |
246 |
$328.67 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,324 |
448 |
$168.84 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
190 |
46 |
$133.72 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
204 |
53 |
$124.16 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,508 |
428 |
$97.37 |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,213 |
372 |
$26.78 |
| E0156 |
Seat attachment, walker |
41 |
12 |
$5.14 |
| A4256 |
Normal, low and high calibrator solution / chips |
84 |
76 |
$4.76 |
| 0124A |
|
25 |
25 |
$0.00 |
| 0051A |
|
38 |
29 |
$0.00 |
| A4258 |
Spring-powered device for lancet, each |
14 |
14 |
$0.00 |