| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,288 |
942 |
$238K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,531 |
5,350 |
$222K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,777 |
5,051 |
$171K |
| 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 |
3,197 |
1,998 |
$165K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,820 |
3,388 |
$157K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
741 |
675 |
$126K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,119 |
848 |
$112K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,410 |
1,999 |
$106K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,793 |
1,499 |
$100K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,423 |
2,085 |
$97K |
| B9998 |
Noc for enteral supplies |
1,756 |
929 |
$96K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,631 |
1,409 |
$87K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,162 |
881 |
$83K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,197 |
2,017 |
$83K |
| E0570 |
Nebulizer, with compressor |
6,280 |
5,574 |
$71K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,151 |
577 |
$70K |
| A4927 |
Gloves, non-sterile, per 100 |
3,222 |
2,729 |
$59K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,029 |
861 |
$56K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
443 |
344 |
$52K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,622 |
1,294 |
$52K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,546 |
1,392 |
$42K |
| 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 |
383 |
171 |
$42K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,537 |
2,136 |
$35K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
2,852 |
2,336 |
$33K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,104 |
1,027 |
$33K |
| E1399 |
Durable medical equipment, miscellaneous |
577 |
179 |
$29K |
| K0001 |
Standard wheelchair |
1,581 |
1,402 |
$26K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
190 |
170 |
$23K |
| A7035 |
Headgear used with positive airway pressure device |
1,109 |
1,010 |
$18K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
918 |
806 |
$17K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
169 |
142 |
$17K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
303 |
242 |
$16K |
| K0003 |
Lightweight wheelchair |
686 |
606 |
$12K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,064 |
2,782 |
$11K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
123 |
88 |
$11K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
345 |
294 |
$9K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
190 |
179 |
$9K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
91 |
61 |
$7K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
77 |
77 |
$5K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
42 |
38 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,180 |
931 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
254 |
198 |
$3K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
186 |
176 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
198 |
157 |
$2K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
38 |
36 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
133 |
118 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
82 |
75 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
105 |
92 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
100 |
88 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
142 |
109 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
261 |
214 |
$1K |
| 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 |
19 |
12 |
$1K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
13 |
12 |
$1K |
| 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 |
258 |
245 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
84 |
74 |
$863.92 |
| K0004 |
High strength, lightweight wheelchair |
13 |
13 |
$797.70 |
| B9002 |
Enteral nutrition infusion pump, any type |
18 |
12 |
$771.14 |
| A7031 |
Face mask interface, replacement for full face mask, each |
27 |
27 |
$767.37 |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
101 |
93 |
$743.20 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
24 |
24 |
$701.63 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
39 |
38 |
$679.10 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
112 |
109 |
$544.39 |
| A4618 |
Breathing circuits |
38 |
25 |
$426.86 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
14 |
13 |
$366.05 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
48 |
39 |
$342.03 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
19 |
14 |
$252.90 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$199.54 |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
40 |
26 |
$166.00 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$139.18 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
13 |
13 |
$132.05 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
31 |
26 |
$124.54 |
| S8189 |
Tracheostomy supply, not otherwise classified |
24 |
13 |
$103.25 |
| A4565 |
Slings |
15 |
14 |
$101.72 |
| E0156 |
Seat attachment, walker |
14 |
14 |
$0.00 |