| 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 |
283 |
265 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
148 |
139 |
$14K |
| A7030 |
Full face mask used with positive airway pressure device, each |
168 |
156 |
$14K |
| A7031 |
Face mask interface, replacement for full face mask, each |
165 |
153 |
$14K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
380 |
357 |
$11K |
| E0601 |
Continuous positive airway pressure (cpap) device |
137 |
124 |
$11K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
212 |
200 |
$11K |
| 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) |
69 |
59 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
412 |
387 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
172 |
158 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
228 |
212 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
108 |
105 |
$2K |
| E0570 |
Nebulizer, with compressor |
144 |
133 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
87 |
75 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
41 |
38 |
$2K |
| K0001 |
Standard wheelchair |
105 |
85 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
168 |
156 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
116 |
106 |
$899.30 |
| A4927 |
Gloves, non-sterile, per 100 |
42 |
32 |
$590.24 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
23 |
13 |
$0.00 |