| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,529 |
2,828 |
$2.59M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
43,938 |
40,384 |
$1.76M |
| 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 |
7,215 |
5,823 |
$1.33M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,883 |
8,695 |
$1.16M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,645 |
2,454 |
$1.05M |
| 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 |
7,851 |
6,534 |
$780K |
| 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 |
5,991 |
5,316 |
$565K |
| 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 |
6,168 |
5,338 |
$465K |
| 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 |
967 |
811 |
$417K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,965 |
2,772 |
$379K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
19,798 |
18,364 |
$308K |
| B9998 |
Noc for enteral supplies |
3,911 |
3,263 |
$225K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,089 |
2,995 |
$168K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,515 |
2,279 |
$154K |
| E0619 |
Apnea monitor, with recording feature |
863 |
788 |
$149K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,809 |
4,525 |
$146K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,721 |
3,510 |
$128K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,620 |
1,516 |
$113K |
| 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 |
948 |
654 |
$113K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,737 |
4,472 |
$87K |
| 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 |
390 |
332 |
$84K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,283 |
1,230 |
$82K |
| 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 |
1,703 |
1,541 |
$59K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,998 |
2,826 |
$58K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,590 |
3,286 |
$54K |
| A7035 |
Headgear used with positive airway pressure device |
4,364 |
4,112 |
$45K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,195 |
2,056 |
$41K |
| A7037 |
Tubing used with positive airway pressure device |
5,619 |
5,290 |
$40K |
| E1392 |
Portable oxygen concentrator, rental |
3,839 |
3,531 |
$40K |
| E0570 |
Nebulizer, with compressor |
3,336 |
3,026 |
$38K |
| E0776 |
Iv pole |
1,773 |
1,687 |
$38K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
67 |
62 |
$37K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,940 |
1,823 |
$36K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
15,871 |
14,959 |
$33K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
949 |
871 |
$32K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,138 |
904 |
$26K |
| K0001 |
Standard wheelchair |
1,209 |
1,117 |
$25K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,490 |
1,253 |
$16K |
| B4100 |
Food thickener, administered orally, per ounce |
212 |
196 |
$16K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
625 |
511 |
$15K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,058 |
1,011 |
$14K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
163 |
152 |
$11K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
42 |
37 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,407 |
2,271 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
1,180 |
1,004 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
761 |
596 |
$5K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
932 |
885 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,319 |
2,840 |
$4K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
265 |
231 |
$3K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
101 |
91 |
$2K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
113 |
101 |
$2K |
| A4623 |
Tracheostomy, inner cannula |
28 |
24 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
287 |
234 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
30 |
25 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
214 |
191 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
121 |
99 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
29 |
25 |
$927.04 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
31 |
27 |
$853.06 |
| A7015 |
Aerosol mask, used with dme nebulizer |
432 |
370 |
$282.56 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$254.70 |
| A7525 |
Tracheostomy mask, each |
144 |
107 |
$108.90 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
27 |
25 |
$83.76 |
| A7036 |
Chinstrap used with positive airway pressure device |
13 |
12 |
$58.34 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
30 |
24 |
$13.31 |