| 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 |
37,114 |
32,741 |
$859K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,133 |
796 |
$443K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,027 |
2,078 |
$120K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,562 |
15,491 |
$90K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,320 |
2,135 |
$77K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,695 |
3,425 |
$72K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
324 |
226 |
$69K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,149 |
3,753 |
$67K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,487 |
2,262 |
$55K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,920 |
2,685 |
$52K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,184 |
1,983 |
$46K |
| E1392 |
Portable oxygen concentrator, rental |
5,450 |
4,901 |
$44K |
| A4623 |
Tracheostomy, inner cannula |
394 |
337 |
$29K |
| 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 |
189 |
177 |
$26K |
| E0570 |
Nebulizer, with compressor |
6,420 |
5,859 |
$25K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,465 |
3,126 |
$20K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
364 |
337 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,716 |
7,986 |
$20K |
| A7035 |
Headgear used with positive airway pressure device |
2,633 |
2,404 |
$19K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
970 |
898 |
$15K |
| 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 |
720 |
518 |
$13K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
311 |
195 |
$12K |
| 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 |
407 |
252 |
$12K |
| A4605 |
Tracheal suction catheter, closed system, each |
69 |
66 |
$11K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,275 |
2,082 |
$11K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
781 |
712 |
$9K |
| A7526 |
Tracheostomy tube collar/holder, each |
407 |
355 |
$8K |
| K0001 |
Standard wheelchair |
966 |
868 |
$7K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
88 |
83 |
$6K |
| A7000 |
Canister, disposable, used with suction pump, each |
586 |
472 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
560 |
489 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,357 |
3,730 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
452 |
433 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
325 |
292 |
$3K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
146 |
132 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
81 |
69 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
249 |
225 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
206 |
186 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
284 |
265 |
$943.32 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
210 |
161 |
$657.50 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
121 |
105 |
$290.30 |
| K0003 |
Lightweight wheelchair |
32 |
24 |
$276.48 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
741 |
654 |
$159.32 |
| A7015 |
Aerosol mask, used with dme nebulizer |
321 |
284 |
$137.14 |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
14 |
12 |
$115.85 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
13 |
12 |
$54.40 |
| A7525 |
Tracheostomy mask, each |
15 |
13 |
$7.54 |