| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
6,092 |
5,630 |
$3.67M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
21,551 |
8,528 |
$2.97M |
| E1399 |
Durable medical equipment, miscellaneous |
2,623 |
2,152 |
$1.80M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,030 |
1,958 |
$1.76M |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
6,374 |
5,188 |
$1.43M |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
19,402 |
16,793 |
$942K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
430 |
394 |
$906K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,351 |
11,964 |
$569K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,786 |
2,575 |
$524K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
390 |
370 |
$483K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
5,068 |
3,480 |
$473K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,708 |
1,670 |
$463K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,553 |
2,461 |
$396K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
3,914 |
1,788 |
$339K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,861 |
2,802 |
$327K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,354 |
2,275 |
$284K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,587 |
1,520 |
$278K |
| A4927 |
Gloves, non-sterile, per 100 |
9,695 |
9,265 |
$275K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,260 |
1,073 |
$262K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,956 |
1,852 |
$247K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
139 |
131 |
$237K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,709 |
2,606 |
$230K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,243 |
1,116 |
$227K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,538 |
1,476 |
$213K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,063 |
1,041 |
$199K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,959 |
1,839 |
$142K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,226 |
1,045 |
$140K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
525 |
483 |
$119K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,773 |
1,697 |
$117K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,731 |
2,531 |
$112K |
| 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 |
643 |
539 |
$106K |
| K0040 |
Adjustable angle footplate, each |
1,107 |
958 |
$102K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
311 |
306 |
$93K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
464 |
400 |
$80K |
| 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 |
308 |
271 |
$79K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
446 |
424 |
$78K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,344 |
1,308 |
$78K |
| A4217 |
Sterile water/saline, 500 ml |
1,400 |
1,222 |
$76K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,346 |
1,306 |
$72K |
| E2300 |
Wheelchair accessory, power seat elevation system, any type |
33 |
25 |
$70K |
| K0005 |
Ultralightweight wheelchair |
41 |
39 |
$69K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
553 |
531 |
$68K |
| A4605 |
Tracheal suction catheter, closed system, each |
248 |
233 |
$67K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
319 |
304 |
$65K |
| B9998 |
Noc for enteral supplies |
1,276 |
943 |
$62K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,167 |
982 |
$60K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
52 |
49 |
$50K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
348 |
332 |
$45K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,092 |
925 |
$45K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
152 |
147 |
$44K |
| A7526 |
Tracheostomy tube collar/holder, each |
827 |
780 |
$43K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
177 |
166 |
$42K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
532 |
487 |
$42K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,148 |
1,981 |
$40K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,249 |
1,185 |
$33K |
| A4623 |
Tracheostomy, inner cannula |
177 |
164 |
$29K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
618 |
538 |
$28K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
83 |
77 |
$28K |
| E0601 |
Continuous positive airway pressure (cpap) device |
647 |
630 |
$27K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
792 |
766 |
$23K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
57 |
57 |
$22K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
81 |
77 |
$22K |
| E0986 |
Manual wheelchair accessory, power assist system |
13 |
12 |
$22K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
510 |
481 |
$21K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,472 |
1,399 |
$19K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
237 |
226 |
$19K |
| E2298 |
Complex rehabilitative power wheelchair accessory, power seat elevation system, any type |
12 |
12 |
$18K |
| K0001 |
Standard wheelchair |
701 |
686 |
$17K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
369 |
364 |
$15K |
| 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 |
594 |
580 |
$15K |
| E0277 |
Powered pressure-reducing air mattress |
54 |
53 |
$14K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,084 |
1,005 |
$14K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
128 |
105 |
$13K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
417 |
329 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
881 |
863 |
$13K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
85 |
84 |
$12K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
672 |
630 |
$12K |
| E1392 |
Portable oxygen concentrator, rental |
445 |
435 |
$12K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
366 |
341 |
$10K |
| K0003 |
Lightweight wheelchair |
196 |
196 |
$10K |
| A7002 |
Tubing, used with suction pump, each |
1,523 |
1,371 |
$10K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
62 |
43 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
202 |
193 |
$8K |
| B9002 |
Enteral nutrition infusion pump, any type |
96 |
85 |
$8K |
| A4402 |
Lubricant, per ounce |
737 |
716 |
$8K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
69 |
68 |
$7K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
757 |
675 |
$7K |
| A4332 |
Lubricant, individual sterile packet, each |
364 |
341 |
$7K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
178 |
147 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
70 |
69 |
$7K |
| E0953 |
Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each |
38 |
36 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
227 |
220 |
$5K |
| A4245 |
Alcohol wipes, per box |
958 |
923 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
234 |
192 |
$4K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
68 |
64 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
906 |
880 |
$4K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
117 |
113 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
87 |
85 |
$3K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
25 |
24 |
$3K |
| E0570 |
Nebulizer, with compressor |
335 |
332 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
225 |
202 |
$3K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
86 |
85 |
$3K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
37 |
28 |
$3K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
16 |
14 |
$2K |
| S8189 |
Tracheostomy supply, not otherwise classified |
128 |
104 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
37 |
37 |
$2K |
| K0019 |
Arm pad, replacement only, each |
121 |
98 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
191 |
191 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
28 |
24 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
57 |
54 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
520 |
473 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
25 |
25 |
$1K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
21 |
13 |
$900.90 |
| K0002 |
Standard hemi (low seat) wheelchair |
26 |
26 |
$804.16 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
52 |
49 |
$710.44 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
39 |
37 |
$501.83 |
| A4244 |
Alcohol or peroxide, per pint |
174 |
168 |
$279.83 |
| A4657 |
Syringe, with or without needle, each |
12 |
12 |
$9.80 |