| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
224,659 |
220,202 |
$20.19M |
| 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 |
5,274 |
4,787 |
$6.08M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
19,266 |
16,250 |
$3.59M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,895 |
2,522 |
$3.43M |
| A7030 |
Full face mask used with positive airway pressure device, each |
33,906 |
33,387 |
$3.36M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
185,696 |
176,174 |
$3.12M |
| E0601 |
Continuous positive airway pressure (cpap) device |
51,960 |
51,432 |
$2.91M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
19,171 |
18,811 |
$2.41M |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
21,629 |
21,118 |
$2.36M |
| 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) |
18,386 |
18,137 |
$2.23M |
| 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 |
6,981 |
6,364 |
$1.93M |
| A7031 |
Face mask interface, replacement for full face mask, each |
33,614 |
33,109 |
$1.89M |
| T4541 |
Incontinence product, disposable underpad, large, each |
16,346 |
15,755 |
$1.69M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,891 |
10,527 |
$1.57M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,546 |
1,216 |
$1.44M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,534 |
10,365 |
$1.44M |
| E1399 |
Durable medical equipment, miscellaneous |
5,207 |
4,442 |
$1.38M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12,999 |
12,670 |
$1.37M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,499 |
1,448 |
$1.33M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
8,888 |
2,440 |
$1.31M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,914 |
9,754 |
$1.25M |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
4,578 |
4,509 |
$1.19M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
7,876 |
7,485 |
$1.17M |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
29,995 |
29,637 |
$1.16M |
| E0570 |
Nebulizer, with compressor |
45,728 |
45,257 |
$1.11M |
| 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 |
3,048 |
2,687 |
$1.03M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,694 |
6,497 |
$1.03M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
18,645 |
18,414 |
$1.01M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
4,772 |
4,541 |
$940K |
| K0001 |
Standard wheelchair |
40,015 |
39,313 |
$922K |
| B9998 |
Noc for enteral supplies |
9,063 |
8,016 |
$899K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,512 |
6,362 |
$856K |
| B9002 |
Enteral nutrition infusion pump, any type |
10,560 |
10,332 |
$852K |
| 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 |
1,473 |
1,340 |
$833K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,647 |
4,570 |
$750K |
| 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 |
5,643 |
5,040 |
$687K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
10,862 |
10,677 |
$667K |
| K0003 |
Lightweight wheelchair |
16,178 |
15,915 |
$646K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,881 |
3,721 |
$614K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
64,395 |
63,360 |
$563K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
9,056 |
8,865 |
$562K |
| A7035 |
Headgear used with positive airway pressure device |
27,836 |
27,292 |
$533K |
| E1392 |
Portable oxygen concentrator, rental |
17,002 |
16,859 |
$520K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
11,380 |
11,132 |
$515K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,248 |
5,126 |
$510K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,363 |
2,318 |
$455K |
| 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 |
3,689 |
3,111 |
$435K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
8,975 |
8,792 |
$402K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,031 |
931 |
$384K |
| 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 |
1,516 |
1,398 |
$379K |
| E0277 |
Powered pressure-reducing air mattress |
1,531 |
1,491 |
$355K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
3,819 |
3,338 |
$353K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,822 |
2,748 |
$341K |
| A4217 |
Sterile water/saline, 500 ml |
3,277 |
2,828 |
$336K |
| 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 |
2,418 |
2,217 |
$320K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
3,218 |
3,118 |
$315K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
4,249 |
4,064 |
$301K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,899 |
2,807 |
$296K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,766 |
3,450 |
$279K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,055 |
1,984 |
$262K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,175 |
3,012 |
$260K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
5,637 |
1,217 |
$259K |
| E0700 |
Safety equipment, device or accessory, any type |
3,190 |
3,175 |
$255K |
| A7037 |
Tubing used with positive airway pressure device |
13,843 |
13,694 |
$251K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
49,109 |
45,092 |
$247K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
20,496 |
20,214 |
$245K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,096 |
1,205 |
$227K |
| 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 |
1,175 |
1,091 |
$222K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
3,142 |
3,108 |
$218K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
943 |
826 |
$217K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,711 |
2,583 |
$212K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,709 |
1,465 |
$205K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,371 |
2,778 |
$201K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
4,643 |
2,916 |
$196K |
| A4927 |
Gloves, non-sterile, per 100 |
18,858 |
17,624 |
$191K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,191 |
3,138 |
$184K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
3,713 |
3,658 |
$179K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
5,932 |
5,787 |
$172K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,483 |
3,348 |
$165K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
7,470 |
7,115 |
$163K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,081 |
2,770 |
$160K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,437 |
6,102 |
$156K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,508 |
2,067 |
$141K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,337 |
3,276 |
$136K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
12,480 |
12,240 |
$135K |
| K0007 |
Extra heavy duty wheelchair |
1,392 |
1,365 |
$133K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,407 |
2,391 |
$132K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
1,581 |
1,535 |
$126K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
2,910 |
2,800 |
$119K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,563 |
1,510 |
$113K |
| A4322 |
Irrigation syringe, bulb or piston, each |
5,573 |
4,920 |
$112K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
982 |
918 |
$104K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,748 |
1,702 |
$102K |
| A7000 |
Canister, disposable, used with suction pump, each |
5,603 |
5,284 |
$100K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,335 |
1,254 |
$97K |
| 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 |
603 |
565 |
$90K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
381 |
375 |
$86K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
9,481 |
8,653 |
$85K |
| E0776 |
Iv pole |
6,928 |
6,758 |
$84K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,548 |
1,416 |
$84K |
| A4649 |
Surgical supply; miscellaneous |
826 |
723 |
$84K |
| A4670 |
Automatic blood pressure monitor |
1,850 |
1,824 |
$80K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
519 |
440 |
$80K |
| A4618 |
Breathing circuits |
2,022 |
1,735 |
$74K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
70 |
69 |
$71K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
413 |
407 |
$66K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
952 |
670 |
$64K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
637 |
572 |
$62K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
200 |
198 |
$61K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
550 |
532 |
$59K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
715 |
710 |
$52K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
76 |
75 |
$51K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
940 |
932 |
$50K |
| A7008 |
Large volume nebulizer, disposable, prefilled, used with aerosol compressor |
407 |
360 |
$48K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,180 |
1,152 |
$47K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
874 |
802 |
$46K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,434 |
1,381 |
$44K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,794 |
1,718 |
$44K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,845 |
3,435 |
$42K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,779 |
2,688 |
$39K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
892 |
885 |
$39K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
496 |
452 |
$39K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,215 |
3,046 |
$38K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
2,208 |
2,080 |
$38K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
602 |
578 |
$37K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
900 |
867 |
$37K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
172 |
168 |
$36K |
| A6260 |
Wound cleansers, any type, any size |
1,663 |
1,539 |
$36K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
302 |
297 |
$36K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,597 |
1,502 |
$32K |
| A4554 |
Disposable underpads, all sizes |
958 |
933 |
$32K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,149 |
1,121 |
$31K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
2,173 |
2,121 |
$29K |
| E0156 |
Seat attachment, walker |
2,889 |
2,826 |
$29K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,076 |
3,835 |
$29K |
| K0006 |
Heavy duty wheelchair |
606 |
595 |
$28K |
| K0040 |
Adjustable angle footplate, each |
315 |
293 |
$26K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,100 |
2,056 |
$24K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
746 |
707 |
$24K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
304 |
298 |
$23K |
| B4100 |
Food thickener, administered orally, per ounce |
677 |
664 |
$23K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
2,126 |
2,096 |
$23K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
99 |
99 |
$21K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
380 |
360 |
$18K |
| 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 |
55 |
53 |
$16K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,650 |
1,630 |
$16K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,853 |
1,764 |
$16K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,337 |
1,299 |
$15K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
10,883 |
10,588 |
$14K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,063 |
1,928 |
$14K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
477 |
438 |
$14K |
| A4332 |
Lubricant, individual sterile packet, each |
1,594 |
1,522 |
$14K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
777 |
757 |
$14K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
256 |
249 |
$14K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,879 |
1,849 |
$14K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
1,678 |
1,645 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
1,885 |
1,758 |
$12K |
| A4335 |
Incontinence supply; miscellaneous |
695 |
683 |
$12K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
447 |
430 |
$12K |
| E0241 |
Bath tub wall rail, each |
545 |
501 |
$12K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,747 |
2,678 |
$12K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
851 |
846 |
$12K |
| E0245 |
Tub stool or bench |
280 |
275 |
$11K |
| E2374 |
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
32 |
28 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
320 |
294 |
$11K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
96 |
95 |
$10K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
349 |
332 |
$10K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
701 |
658 |
$10K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
942 |
854 |
$10K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
103 |
98 |
$10K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,401 |
1,365 |
$9K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
75 |
64 |
$9K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,352 |
1,299 |
$9K |
| A7015 |
Aerosol mask, used with dme nebulizer |
5,480 |
5,281 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,881 |
3,774 |
$8K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
83 |
51 |
$8K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
91 |
90 |
$8K |
| A7525 |
Tracheostomy mask, each |
1,338 |
1,230 |
$6K |
| A4402 |
Lubricant, per ounce |
924 |
893 |
$6K |
| K0002 |
Standard hemi (low seat) wheelchair |
210 |
210 |
$6K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
1,979 |
1,912 |
$6K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
71 |
65 |
$6K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
108 |
101 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
727 |
687 |
$5K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
360 |
358 |
$5K |
| E0244 |
Raised toilet seat |
79 |
78 |
$4K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
30 |
27 |
$4K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
29 |
27 |
$4K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
73 |
65 |
$4K |
| E0310 |
Bed side rails, full length |
464 |
462 |
$3K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
39 |
36 |
$3K |
| A4623 |
Tracheostomy, inner cannula |
60 |
55 |
$2K |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
107 |
99 |
$2K |
| 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 |
76 |
74 |
$2K |
| 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 |
25 |
24 |
$2K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
37 |
37 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
38 |
25 |
$2K |
| E1355 |
Stand/rack |
100 |
96 |
$2K |
| A6242 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15 |
14 |
$2K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
214 |
210 |
$2K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
48 |
48 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
41 |
40 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
27 |
25 |
$1K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
13 |
12 |
$988.22 |
| A4367 |
Ostomy belt, each |
133 |
133 |
$985.95 |
| E1372 |
Immersion external heater for nebulizer |
104 |
101 |
$741.51 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
12 |
12 |
$526.97 |
| A7012 |
Water collection device, used with large volume nebulizer |
108 |
101 |
$515.28 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
86 |
85 |
$455.79 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
29 |
28 |
$448.20 |
| E0243 |
Toilet rail, each |
12 |
12 |
$392.78 |
| E0705 |
Transfer device, any type, each |
12 |
12 |
$357.96 |
| A4245 |
Alcohol wipes, per box |
55 |
52 |
$127.05 |
| A4657 |
Syringe, with or without needle, each |
12 |
12 |
$11.43 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
43 |
42 |
$2.67 |
| A4616 |
Tubing (oxygen), per foot |
15 |
15 |
$0.72 |