| 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 |
29,031 |
20,980 |
$1.68M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,420 |
822 |
$480K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,230 |
2,502 |
$448K |
| A4554 |
Disposable underpads, all sizes |
6,440 |
5,815 |
$333K |
| 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 |
13,329 |
11,251 |
$284K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,665 |
1,456 |
$249K |
| 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 |
1,046 |
590 |
$248K |
| 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 |
3,439 |
1,956 |
$246K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,750 |
1,609 |
$244K |
| S5165 |
Home modifications; per service |
357 |
232 |
$238K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,761 |
1,608 |
$228K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,053 |
4,241 |
$226K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,437 |
5,627 |
$203K |
| 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 |
3,103 |
1,952 |
$198K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
482 |
369 |
$180K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
604 |
388 |
$164K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,068 |
950 |
$151K |
| K0003 |
Lightweight wheelchair |
5,556 |
4,657 |
$147K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,047 |
1,818 |
$145K |
| 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 |
1,798 |
1,202 |
$141K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,142 |
1,589 |
$139K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
603 |
545 |
$131K |
| 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 |
1,891 |
1,051 |
$129K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,765 |
2,435 |
$119K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
723 |
684 |
$103K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
743 |
671 |
$92K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
743 |
682 |
$90K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
723 |
487 |
$89K |
| 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) |
1,020 |
768 |
$78K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,548 |
1,045 |
$74K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,246 |
967 |
$73K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,751 |
1,589 |
$71K |
| A4623 |
Tracheostomy, inner cannula |
1,282 |
815 |
$70K |
| E0277 |
Powered pressure-reducing air mattress |
426 |
264 |
$68K |
| E0570 |
Nebulizer, with compressor |
3,122 |
3,003 |
$62K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
971 |
621 |
$61K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
730 |
651 |
$57K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,460 |
900 |
$55K |
| K0007 |
Extra heavy duty wheelchair |
963 |
703 |
$53K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
381 |
347 |
$49K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
367 |
325 |
$47K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,353 |
1,183 |
$46K |
| K0001 |
Standard wheelchair |
2,980 |
2,571 |
$45K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,113 |
974 |
$45K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,467 |
5,126 |
$44K |
| E1392 |
Portable oxygen concentrator, rental |
2,205 |
1,841 |
$43K |
| 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 |
514 |
371 |
$42K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
362 |
328 |
$40K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,894 |
1,368 |
$40K |
| A7035 |
Headgear used with positive airway pressure device |
2,637 |
2,332 |
$40K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
702 |
642 |
$39K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,715 |
1,407 |
$37K |
| A7037 |
Tubing used with positive airway pressure device |
1,490 |
1,331 |
$33K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,089 |
997 |
$27K |
| L8501 |
Tracheostomy speaking valve |
374 |
289 |
$27K |
| 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 |
554 |
312 |
$26K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,107 |
934 |
$26K |
| K0006 |
Heavy duty wheelchair |
870 |
646 |
$26K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
236 |
128 |
$24K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,369 |
1,195 |
$24K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
828 |
618 |
$23K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
576 |
399 |
$23K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
1,124 |
990 |
$23K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
228 |
211 |
$22K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
722 |
638 |
$21K |
| B9998 |
Noc for enteral supplies |
2,444 |
1,085 |
$20K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,523 |
1,039 |
$20K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,587 |
1,172 |
$20K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,083 |
770 |
$14K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
624 |
571 |
$13K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
94 |
85 |
$11K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
94 |
88 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
573 |
455 |
$9K |
| E0156 |
Seat attachment, walker |
1,029 |
909 |
$9K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,574 |
1,358 |
$9K |
| E0912 |
Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar |
288 |
205 |
$9K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
298 |
245 |
$8K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
117 |
97 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,552 |
2,873 |
$7K |
| B9004 |
Parenteral nutrition infusion pump, portable |
40 |
40 |
$7K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
36 |
24 |
$6K |
| K0002 |
Standard hemi (low seat) wheelchair |
268 |
226 |
$5K |
| 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) |
14 |
12 |
$4K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
309 |
183 |
$4K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
467 |
426 |
$4K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
309 |
244 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
1,327 |
936 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
863 |
669 |
$3K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
437 |
417 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,627 |
1,435 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
56 |
51 |
$2K |
| E0776 |
Iv pole |
43 |
38 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
860 |
719 |
$1K |
| E2202 |
Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches |
164 |
108 |
$1K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
17 |
12 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
871 |
787 |
$985.79 |
| A7012 |
Water collection device, used with large volume nebulizer |
422 |
298 |
$979.66 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
21 |
13 |
$883.36 |
| T2025 |
Waiver services; not otherwise specified (nos) |
20 |
12 |
$738.67 |
| E1020 |
Residual limb support system for wheelchair, any type |
13 |
13 |
$700.76 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
157 |
136 |
$674.02 |
| E1399 |
Durable medical equipment, miscellaneous |
44 |
40 |
$530.97 |
| A7525 |
Tracheostomy mask, each |
1,117 |
665 |
$421.08 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
819 |
773 |
$374.35 |