| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,955 |
5,623 |
$164K |
| 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 |
3,242 |
3,130 |
$95K |
| 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 |
2,136 |
2,044 |
$65K |
| 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 |
484 |
445 |
$30K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,492 |
1,411 |
$25K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
4,563 |
4,451 |
$19K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,157 |
1,975 |
$17K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,631 |
5,459 |
$12K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
967 |
928 |
$11K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
331 |
284 |
$9K |
| A7526 |
Tracheostomy tube collar/holder, each |
453 |
453 |
$6K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,300 |
2,232 |
$6K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
254 |
241 |
$5K |
| A4623 |
Tracheostomy, inner cannula |
136 |
136 |
$4K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
3,486 |
3,417 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
229 |
209 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,541 |
3,381 |
$3K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
245 |
232 |
$3K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
905 |
862 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
857 |
827 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
133 |
131 |
$2K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
80 |
70 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
54 |
52 |
$2K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
67 |
64 |
$1K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
52 |
41 |
$1K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
103 |
89 |
$1K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
147 |
135 |
$1K |
| E0776 |
Iv pole |
564 |
537 |
$478.13 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
188 |
168 |
$462.60 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
15 |
13 |
$360.24 |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
94 |
85 |
$346.90 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
51 |
51 |
$274.00 |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
43 |
41 |
$143.70 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
15 |
12 |
$66.24 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
27 |
25 |
$36.35 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
32 |
28 |
$8.62 |