| 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 |
3,236 |
2,618 |
$649K |
| 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 |
1,184 |
924 |
$439K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
630 |
506 |
$349K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,090 |
3,641 |
$263K |
| 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 |
1,449 |
1,172 |
$197K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
577 |
447 |
$176K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,128 |
1,719 |
$125K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,440 |
1,257 |
$97K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,227 |
1,944 |
$74K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
509 |
411 |
$67K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
487 |
398 |
$62K |
| A4335 |
Incontinence supply; miscellaneous |
2,353 |
2,008 |
$59K |
| T4541 |
Incontinence product, disposable underpad, large, each |
845 |
712 |
$49K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
247 |
207 |
$36K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
374 |
304 |
$34K |
| A7030 |
Full face mask used with positive airway pressure device, each |
503 |
445 |
$31K |
| 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) |
329 |
300 |
$31K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,422 |
2,177 |
$28K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,416 |
2,142 |
$28K |
| K0001 |
Standard wheelchair |
1,285 |
1,161 |
$26K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
377 |
303 |
$25K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,031 |
913 |
$25K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
214 |
177 |
$24K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
45 |
26 |
$22K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,825 |
1,703 |
$22K |
| A7031 |
Face mask interface, replacement for full face mask, each |
659 |
611 |
$21K |
| 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 |
197 |
155 |
$17K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
129 |
99 |
$15K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
168 |
127 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
952 |
728 |
$14K |
| A7035 |
Headgear used with positive airway pressure device |
828 |
733 |
$11K |
| E0776 |
Iv pole |
1,046 |
927 |
$9K |
| E0570 |
Nebulizer, with compressor |
132 |
124 |
$8K |
| B4100 |
Food thickener, administered orally, per ounce |
30 |
24 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,303 |
1,121 |
$6K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
35 |
27 |
$5K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
176 |
141 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
115 |
97 |
$4K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
134 |
128 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
182 |
170 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
506 |
446 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
278 |
234 |
$3K |
| 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 |
32 |
25 |
$3K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
16 |
12 |
$2K |
| B9998 |
Noc for enteral supplies |
142 |
106 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
452 |
417 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
15 |
12 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
101 |
91 |
$1K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
103 |
92 |
$891.54 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
15 |
13 |
$811.83 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
14 |
13 |
$655.19 |
| A7000 |
Canister, disposable, used with suction pump, each |
31 |
26 |
$557.81 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
72 |
64 |
$394.12 |
| A7015 |
Aerosol mask, used with dme nebulizer |
257 |
241 |
$346.74 |
| A4657 |
Syringe, with or without needle, each |
92 |
56 |
$189.37 |
| A7002 |
Tubing, used with suction pump, each |
20 |
13 |
$134.99 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
75 |
57 |
$0.00 |
| A9270 |
Non-covered item or service |
398 |
311 |
$0.00 |