| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,389 |
3,786 |
$581K |
| 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 |
2,563 |
2,116 |
$474K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,576 |
2,196 |
$421K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,777 |
6,190 |
$414K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,159 |
6,201 |
$409K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,397 |
3,491 |
$256K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,590 |
1,395 |
$249K |
| 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 |
3,618 |
3,203 |
$205K |
| A4623 |
Tracheostomy, inner cannula |
3,196 |
2,809 |
$183K |
| 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 |
2,761 |
2,472 |
$162K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,715 |
1,509 |
$154K |
| B9998 |
Noc for enteral supplies |
2,478 |
1,984 |
$126K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,287 |
4,400 |
$120K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
5,389 |
4,296 |
$96K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,134 |
720 |
$94K |
| 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 |
1,308 |
1,189 |
$86K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,342 |
2,212 |
$84K |
| E0570 |
Nebulizer, with compressor |
2,309 |
2,121 |
$80K |
| S8189 |
Tracheostomy supply, not otherwise classified |
1,310 |
821 |
$73K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
697 |
561 |
$65K |
| 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) |
345 |
317 |
$59K |
| A7037 |
Tubing used with positive airway pressure device |
2,524 |
2,269 |
$58K |
| A7526 |
Tracheostomy tube collar/holder, each |
5,262 |
4,572 |
$49K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,630 |
1,083 |
$49K |
| A7035 |
Headgear used with positive airway pressure device |
2,332 |
2,060 |
$48K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
336 |
280 |
$46K |
| 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 |
71 |
62 |
$38K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,590 |
1,186 |
$34K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,118 |
4,749 |
$32K |
| A7000 |
Canister, disposable, used with suction pump, each |
5,651 |
4,964 |
$32K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,820 |
4,269 |
$29K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,693 |
3,678 |
$28K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,203 |
1,110 |
$23K |
| K0001 |
Standard wheelchair |
1,763 |
1,472 |
$22K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
1,974 |
1,650 |
$16K |
| A7002 |
Tubing, used with suction pump, each |
4,846 |
3,981 |
$16K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,071 |
1,816 |
$15K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,481 |
2,223 |
$15K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
127 |
113 |
$14K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
554 |
405 |
$14K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,069 |
4,434 |
$13K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
726 |
633 |
$13K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,508 |
1,260 |
$9K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,660 |
2,024 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
112 |
108 |
$8K |
| L8501 |
Tracheostomy speaking valve |
188 |
168 |
$8K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
988 |
888 |
$6K |
| A4618 |
Breathing circuits |
345 |
295 |
$5K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,027 |
1,639 |
$5K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
774 |
725 |
$3K |
| A7525 |
Tracheostomy mask, each |
1,754 |
1,135 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
38 |
37 |
$2K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
218 |
185 |
$2K |
| S8186 |
Swivel adapter |
368 |
262 |
$1K |
| A4616 |
Tubing (oxygen), per foot |
814 |
692 |
$676.82 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
16 |
13 |
$482.20 |
| A4927 |
Gloves, non-sterile, per 100 |
61 |
60 |
$458.60 |
| A4615 |
Cannula, nasal |
334 |
228 |
$273.78 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
15 |
13 |
$100.83 |
| A4217 |
Sterile water/saline, 500 ml |
49 |
38 |
$0.00 |