| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
10,188 |
6,550 |
$6.90M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,337 |
10,404 |
$2.36M |
| 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 |
5,349 |
3,599 |
$1.92M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,006 |
1,358 |
$1.04M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,798 |
10,905 |
$746K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
4,889 |
2,098 |
$729K |
| B9998 |
Noc for enteral supplies |
27,185 |
5,849 |
$727K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
5,898 |
4,003 |
$712K |
| 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 |
3,882 |
2,917 |
$658K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,047 |
2,043 |
$586K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
2,725 |
2,150 |
$549K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
5,871 |
4,905 |
$541K |
| Y2032 |
|
1,657 |
1,434 |
$485K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,202 |
3,586 |
$456K |
| A4217 |
Sterile water/saline, 500 ml |
4,896 |
4,043 |
$433K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
26,131 |
6,969 |
$414K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
4,203 |
2,275 |
$413K |
| A7526 |
Tracheostomy tube collar/holder, each |
7,374 |
5,962 |
$359K |
| E1399 |
Durable medical equipment, miscellaneous |
3,457 |
2,332 |
$351K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
10,062 |
6,990 |
$328K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,100 |
3,045 |
$328K |
| 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 |
1,820 |
1,535 |
$298K |
| S8189 |
Tracheostomy supply, not otherwise classified |
1,978 |
1,024 |
$293K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,476 |
2,060 |
$265K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,213 |
928 |
$256K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,481 |
2,924 |
$222K |
| 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 |
1,334 |
1,168 |
$217K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
518 |
352 |
$193K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,790 |
9,225 |
$184K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,699 |
1,506 |
$169K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,331 |
1,166 |
$112K |
| 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 |
2,219 |
1,681 |
$111K |
| A7000 |
Canister, disposable, used with suction pump, each |
7,484 |
6,144 |
$96K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,985 |
2,703 |
$88K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,111 |
874 |
$84K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,031 |
5,873 |
$80K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,162 |
1,024 |
$79K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
727 |
653 |
$69K |
| A4927 |
Gloves, non-sterile, per 100 |
4,676 |
4,100 |
$58K |
| A7002 |
Tubing, used with suction pump, each |
7,676 |
6,431 |
$56K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
712 |
498 |
$54K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,042 |
2,369 |
$46K |
| 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 |
299 |
241 |
$46K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
5,438 |
4,440 |
$39K |
| 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 |
1,290 |
1,097 |
$34K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,405 |
2,173 |
$28K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,988 |
1,783 |
$24K |
| E0776 |
Iv pole |
378 |
288 |
$23K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
205 |
196 |
$23K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
479 |
383 |
$23K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
697 |
642 |
$21K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,960 |
4,312 |
$14K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
141 |
99 |
$14K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
5,240 |
4,474 |
$13K |
| A4930 |
Gloves, sterile, per pair |
208 |
201 |
$10K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
59 |
49 |
$9K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
30 |
25 |
$8K |
| A4452 |
Tape, waterproof, per 18 square inches |
701 |
583 |
$7K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,797 |
1,321 |
$7K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
43 |
41 |
$4K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
100 |
96 |
$4K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
579 |
530 |
$4K |
| A6214 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
40 |
30 |
$4K |
| A4402 |
Lubricant, per ounce |
1,122 |
1,060 |
$3K |
| A7525 |
Tracheostomy mask, each |
2,910 |
1,745 |
$3K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
43 |
38 |
$3K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
67 |
54 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
257 |
196 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
994 |
747 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
51 |
49 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
822 |
493 |
$1K |
| E0570 |
Nebulizer, with compressor |
20 |
15 |
$785.52 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
107 |
72 |
$693.24 |
| A7037 |
Tubing used with positive airway pressure device |
70 |
51 |
$616.45 |
| A7001 |
Canister, non-disposable, used with suction pump, each |
14 |
13 |
$334.17 |
| B4081 |
Nasogastric tubing with stylet |
20 |
14 |
$319.67 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
39 |
24 |
$260.48 |
| A4332 |
Lubricant, individual sterile packet, each |
36 |
24 |
$230.43 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
92 |
38 |
$58.23 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
28 |
19 |
$32.29 |