| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
172,965 |
170,950 |
$9.04M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
83,901 |
82,807 |
$6.80M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
24,532 |
20,649 |
$6.36M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
31,820 |
30,411 |
$6.00M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
173,902 |
169,267 |
$5.11M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
54,431 |
53,680 |
$4.53M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
72,253 |
71,190 |
$4.36M |
| E0784 |
External ambulatory infusion pump, insulin |
2,604 |
2,296 |
$3.77M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
17,266 |
16,011 |
$2.97M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
6,691 |
6,053 |
$2.96M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
14,014 |
12,937 |
$2.62M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
41,912 |
39,982 |
$2.60M |
| 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 |
15,379 |
14,201 |
$2.52M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
32,514 |
31,038 |
$2.20M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
13,039 |
12,863 |
$2.04M |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
16,673 |
15,179 |
$1.80M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
4,814 |
4,280 |
$1.70M |
| 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 |
31,081 |
21,516 |
$1.69M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
47,233 |
46,537 |
$1.56M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
23,675 |
22,027 |
$1.46M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
17,929 |
16,219 |
$1.45M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
20,335 |
19,104 |
$1.40M |
| 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 |
18,150 |
17,109 |
$1.05M |
| A4927 |
Gloves, non-sterile, per 100 |
189,754 |
186,159 |
$1.04M |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
43,592 |
41,347 |
$965K |
| T4541 |
Incontinence product, disposable underpad, large, each |
35,820 |
33,471 |
$944K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
15,121 |
14,118 |
$939K |
| 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 |
5,763 |
5,130 |
$933K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
10,931 |
10,162 |
$895K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
14,300 |
13,608 |
$797K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,891 |
1,731 |
$760K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
5,600 |
5,094 |
$749K |
| 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 |
19,570 |
13,998 |
$736K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
5,808 |
5,600 |
$716K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
7,301 |
6,499 |
$709K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
14,504 |
13,664 |
$694K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
1,862 |
1,678 |
$657K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,807 |
6,362 |
$637K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
9,676 |
9,086 |
$627K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
5,497 |
5,180 |
$606K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
4,731 |
4,286 |
$587K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
11,345 |
10,475 |
$493K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
7,578 |
7,326 |
$490K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
7,164 |
6,669 |
$471K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
889 |
770 |
$446K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
8,010 |
7,870 |
$442K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
2,819 |
2,654 |
$433K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
18,399 |
16,965 |
$390K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
10,044 |
9,209 |
$384K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
2,314 |
2,121 |
$366K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
31,714 |
30,052 |
$345K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
17,775 |
16,587 |
$341K |
| A4335 |
Incontinence supply; miscellaneous |
66,596 |
51,924 |
$340K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
5,930 |
5,855 |
$338K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
5,094 |
4,716 |
$333K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
6,939 |
6,253 |
$325K |
| 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 |
7,803 |
5,655 |
$324K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
10,155 |
9,326 |
$309K |
| T5999 |
Supply, not otherwise specified |
462 |
409 |
$305K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
876 |
768 |
$295K |
| 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 |
577 |
517 |
$293K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
14,168 |
13,353 |
$287K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
3,019 |
2,645 |
$260K |
| A4670 |
Automatic blood pressure monitor |
4,316 |
4,270 |
$260K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,698 |
4,229 |
$253K |
| 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 |
5,385 |
5,049 |
$236K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
6,201 |
5,886 |
$236K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
2,997 |
2,797 |
$236K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
11,136 |
10,286 |
$234K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
1,682 |
1,480 |
$228K |
| A4452 |
Tape, waterproof, per 18 square inches |
20,329 |
19,136 |
$227K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,796 |
3,656 |
$227K |
| A5120 |
Skin barrier, wipes or swabs, each |
29,930 |
28,189 |
$210K |
| A4453 |
Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
511 |
504 |
$200K |
| A4456 |
Adhesive remover, wipes, any type, each |
23,287 |
22,004 |
$196K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
8,014 |
7,455 |
$186K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
2,490 |
2,338 |
$185K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
4,412 |
4,097 |
$177K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
13,317 |
8,838 |
$172K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
2,107 |
1,936 |
$166K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
2,345 |
2,148 |
$153K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
1,679 |
1,591 |
$153K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
8,652 |
8,257 |
$151K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
1,835 |
1,662 |
$144K |
| A4217 |
Sterile water/saline, 500 ml |
14,808 |
14,140 |
$133K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
5,621 |
5,163 |
$130K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
2,341 |
2,182 |
$126K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
1,680 |
1,599 |
$126K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
1,065 |
1,012 |
$122K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,598 |
3,351 |
$115K |
| E1399 |
Durable medical equipment, miscellaneous |
7,681 |
6,831 |
$113K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
18,368 |
17,603 |
$110K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
19,453 |
17,996 |
$108K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
1,060 |
984 |
$102K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,396 |
2,366 |
$100K |
| 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 |
716 |
576 |
$99K |
| A4259 |
Lancets, per box of 100 |
41,936 |
39,790 |
$98K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
1,943 |
1,871 |
$96K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
1,488 |
1,396 |
$92K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,657 |
2,476 |
$91K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,726 |
1,577 |
$86K |
| E0607 |
Home blood glucose monitor |
2,262 |
2,213 |
$85K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
2,077 |
1,954 |
$85K |
| A5073 |
Ostomy pouch, urinary; for use on barrier with flange (2 piece), each |
1,130 |
1,105 |
$83K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
8,242 |
7,878 |
$77K |
| A4256 |
Normal, low and high calibrator solution / chips |
13,772 |
13,178 |
$75K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,189 |
2,887 |
$74K |
| B9998 |
Noc for enteral supplies |
734 |
624 |
$73K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
3,412 |
3,106 |
$73K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
2,408 |
2,302 |
$72K |
| A4371 |
Ostomy skin barrier, powder, per oz |
13,427 |
12,740 |
$72K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
505 |
437 |
$71K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
5,573 |
5,160 |
$69K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
884 |
838 |
$65K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
4,510 |
4,333 |
$64K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
775 |
734 |
$61K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
985 |
908 |
$58K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
4,806 |
4,489 |
$55K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
628 |
545 |
$49K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
2,894 |
2,654 |
$48K |
| E0241 |
Bath tub wall rail, each |
1,989 |
1,769 |
$48K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,636 |
1,473 |
$48K |
| A4649 |
Surgical supply; miscellaneous |
1,332 |
1,242 |
$47K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,361 |
3,107 |
$42K |
| A6260 |
Wound cleansers, any type, any size |
2,515 |
2,351 |
$41K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
1,521 |
1,427 |
$40K |
| A4367 |
Ostomy belt, each |
7,125 |
6,823 |
$40K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
654 |
585 |
$39K |
| B4100 |
Food thickener, administered orally, per ounce |
555 |
524 |
$39K |
| A4402 |
Lubricant, per ounce |
6,534 |
6,238 |
$38K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
283 |
268 |
$36K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
813 |
785 |
$35K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,616 |
2,412 |
$34K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
493 |
433 |
$34K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,362 |
929 |
$32K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
1,072 |
1,059 |
$28K |
| A4396 |
Ostomy belt with peristomal hernia support |
826 |
731 |
$27K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
991 |
951 |
$26K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
693 |
671 |
$26K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
868 |
765 |
$23K |
| A4332 |
Lubricant, individual sterile packet, each |
2,223 |
2,073 |
$23K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
1,860 |
1,663 |
$23K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
261 |
246 |
$22K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
4,055 |
3,829 |
$22K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
781 |
733 |
$21K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
296 |
287 |
$21K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
4,246 |
4,023 |
$20K |
| E1639 |
Scale, each |
768 |
762 |
$19K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
442 |
434 |
$17K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,988 |
1,904 |
$15K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,367 |
2,220 |
$15K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
146 |
142 |
$15K |
| A4245 |
Alcohol wipes, per box |
8,538 |
8,366 |
$15K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,878 |
1,765 |
$12K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
423 |
402 |
$12K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
873 |
831 |
$11K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
360 |
349 |
$10K |
| A4930 |
Gloves, sterile, per pair |
678 |
646 |
$10K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
461 |
433 |
$9K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
849 |
779 |
$9K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
187 |
175 |
$8K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,367 |
1,255 |
$8K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
292 |
282 |
$7K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
509 |
448 |
$6K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
308 |
297 |
$6K |
| A4459 |
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
47 |
47 |
$5K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
78 |
77 |
$5K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
74 |
68 |
$5K |
| A6235 |
Hydrocolloid 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 |
32 |
26 |
$4K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
94 |
93 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
321 |
320 |
$4K |
| A9281 |
Reaching/grabbing device, any type, any length, each |
173 |
171 |
$4K |
| A5052 |
Ostomy pouch, closed; without barrier attached (1 piece), each |
54 |
52 |
$4K |
| E0244 |
Raised toilet seat |
63 |
63 |
$4K |
| A4400 |
Ostomy irrigation set |
52 |
50 |
$4K |
| A4404 |
Ostomy ring, each |
182 |
173 |
$3K |
| A9270 |
Non-covered item or service |
2,508 |
2,203 |
$3K |
| E0245 |
Tub stool or bench |
67 |
66 |
$3K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
44 |
37 |
$3K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
260 |
234 |
$2K |
| A4392 |
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
40 |
36 |
$2K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
69 |
66 |
$2K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
183 |
173 |
$2K |
| A4231 |
Infusion set for external insulin pump, needle type |
40 |
39 |
$2K |
| A6254 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
110 |
103 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
28 |
27 |
$2K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
79 |
79 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
31 |
27 |
$2K |
| E0305 |
Bed side rails, half length |
38 |
38 |
$2K |
| A4363 |
Ostomy clamp, any type, replacement only, each |
584 |
557 |
$2K |
| E0215 |
Electric heat pad, moist |
28 |
28 |
$2K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
13 |
13 |
$2K |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
13 |
12 |
$2K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
42 |
36 |
$1K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
51 |
50 |
$1K |
| E0243 |
Toilet rail, each |
30 |
29 |
$1K |
| A6455 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
28 |
25 |
$798.45 |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
26 |
24 |
$757.17 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
135 |
125 |
$626.34 |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
12 |
12 |
$437.08 |
| A4246 |
Betadine or phisohex solution, per pint |
63 |
62 |
$327.00 |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
13 |
12 |
$314.14 |
| A4258 |
Spring-powered device for lancet, each |
30 |
27 |
$278.77 |
| E0325 |
Urinal; male, jug-type, any material |
38 |
38 |
$210.49 |