| 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 |
7,566 |
6,891 |
$1.05M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
19,813 |
19,625 |
$951K |
| 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 |
5,202 |
4,887 |
$826K |
| 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 |
1,353 |
1,233 |
$524K |
| 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 |
2,730 |
2,497 |
$307K |
| 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 |
2,964 |
2,774 |
$287K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,624 |
6,555 |
$243K |
| 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 |
582 |
534 |
$199K |
| B9998 |
Noc for enteral supplies |
3,549 |
3,187 |
$173K |
| 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 |
847 |
780 |
$164K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,614 |
11,531 |
$133K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,074 |
2,039 |
$112K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,659 |
2,617 |
$103K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,163 |
1,155 |
$80K |
| 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) |
971 |
970 |
$72K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,454 |
2,423 |
$60K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,623 |
6,552 |
$56K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,096 |
1,005 |
$51K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
985 |
758 |
$50K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,970 |
1,952 |
$47K |
| E0570 |
Nebulizer, with compressor |
6,837 |
6,785 |
$47K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
356 |
331 |
$38K |
| A7035 |
Headgear used with positive airway pressure device |
3,175 |
3,138 |
$34K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,006 |
6,882 |
$33K |
| A7037 |
Tubing used with positive airway pressure device |
2,996 |
2,963 |
$30K |
| E1392 |
Portable oxygen concentrator, rental |
3,677 |
3,628 |
$24K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
893 |
878 |
$18K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
1,993 |
1,825 |
$18K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
39 |
39 |
$18K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,539 |
1,526 |
$16K |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
447 |
419 |
$14K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,167 |
3,149 |
$14K |
| 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 |
388 |
365 |
$11K |
| E0776 |
Iv pole |
1,332 |
1,325 |
$11K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
618 |
603 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,195 |
1,187 |
$7K |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
1,321 |
1,202 |
$4K |
| J7606 |
Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms |
14 |
12 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,310 |
3,121 |
$3K |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
494 |
457 |
$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 |
45 |
45 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
137 |
137 |
$683.31 |
| K0001 |
Standard wheelchair |
12 |
12 |
$355.13 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
18 |
18 |
$317.35 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
186 |
182 |
$266.04 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
13 |
13 |
$2.60 |