| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
26,691 |
21,816 |
$2.29M |
| 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 |
3,771 |
2,688 |
$1.39M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
9,990 |
5,290 |
$1.13M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
31,737 |
18,465 |
$1.12M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,018 |
1,573 |
$757K |
| 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 |
5,679 |
4,237 |
$609K |
| 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 |
4,211 |
3,382 |
$411K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
3,333 |
2,694 |
$241K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,185 |
4,387 |
$166K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,361 |
2,117 |
$144K |
| 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 |
565 |
422 |
$108K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,314 |
959 |
$95K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,215 |
2,698 |
$93K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
14,691 |
8,673 |
$91K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,044 |
703 |
$74K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
8,429 |
5,204 |
$57K |
| E1392 |
Portable oxygen concentrator, rental |
5,701 |
3,276 |
$51K |
| A7037 |
Tubing used with positive airway pressure device |
4,366 |
2,853 |
$36K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,432 |
933 |
$34K |
| A7035 |
Headgear used with positive airway pressure device |
3,234 |
2,160 |
$31K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
434 |
284 |
$25K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
472 |
269 |
$25K |
| 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 |
109 |
94 |
$24K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,191 |
5,631 |
$24K |
| E0570 |
Nebulizer, with compressor |
4,277 |
2,801 |
$16K |
| E0776 |
Iv pole |
1,723 |
1,291 |
$14K |
| 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 |
55 |
36 |
$13K |
| B9998 |
Noc for enteral supplies |
308 |
138 |
$10K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
548 |
349 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
256 |
185 |
$6K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
327 |
213 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,385 |
857 |
$3K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
16 |
12 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
949 |
627 |
$363.35 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
60 |
40 |
$334.46 |