| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,244 |
1,994 |
$1.71M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
20,627 |
20,003 |
$1.27M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
5,171 |
5,066 |
$1.13M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,022 |
950 |
$805K |
| A4217 |
Sterile water/saline, 500 ml |
3,284 |
2,836 |
$485K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,371 |
2,122 |
$477K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,696 |
1,506 |
$297K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,548 |
5,289 |
$282K |
| K0001 |
Standard wheelchair |
11,926 |
11,561 |
$232K |
| E1392 |
Portable oxygen concentrator, rental |
7,565 |
7,398 |
$227K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,885 |
3,737 |
$223K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,511 |
1,232 |
$199K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,175 |
1,123 |
$191K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,524 |
2,428 |
$171K |
| 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 |
6,199 |
6,079 |
$170K |
| A4927 |
Gloves, non-sterile, per 100 |
5,310 |
4,984 |
$162K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,948 |
2,902 |
$137K |
| S8189 |
Tracheostomy supply, not otherwise classified |
7,782 |
2,933 |
$136K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,348 |
1,272 |
$135K |
| E0570 |
Nebulizer, with compressor |
5,624 |
5,489 |
$134K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,046 |
1,789 |
$131K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,966 |
1,836 |
$122K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
985 |
759 |
$122K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,038 |
1,021 |
$99K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
981 |
943 |
$93K |
| A4605 |
Tracheal suction catheter, closed system, each |
344 |
316 |
$81K |
| A4623 |
Tracheostomy, inner cannula |
355 |
328 |
$80K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,888 |
1,871 |
$78K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
641 |
626 |
$77K |
| 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 |
541 |
467 |
$76K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,423 |
1,369 |
$72K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,280 |
1,205 |
$61K |
| 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 |
353 |
295 |
$59K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
377 |
351 |
$55K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
745 |
743 |
$48K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
4,498 |
2,432 |
$47K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
912 |
880 |
$41K |
| A7031 |
Face mask interface, replacement for full face mask, each |
903 |
876 |
$35K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
924 |
887 |
$34K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,129 |
1,985 |
$31K |
| A7035 |
Headgear used with positive airway pressure device |
1,413 |
1,402 |
$30K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
925 |
836 |
$27K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,943 |
4,548 |
$22K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
737 |
691 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
973 |
920 |
$20K |
| E0635 |
Patient lift, electric with seat or sling |
235 |
218 |
$20K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,948 |
1,753 |
$18K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
877 |
788 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,100 |
3,048 |
$17K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
147 |
130 |
$17K |
| A4670 |
Automatic blood pressure monitor |
235 |
231 |
$17K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
76 |
75 |
$16K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
217 |
187 |
$15K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
261 |
221 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
2,399 |
2,091 |
$14K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,218 |
1,185 |
$14K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
362 |
359 |
$14K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
900 |
890 |
$12K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
625 |
580 |
$12K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
68 |
64 |
$10K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
162 |
160 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
559 |
551 |
$9K |
| A4245 |
Alcohol wipes, per box |
737 |
702 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
266 |
240 |
$5K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
80 |
67 |
$5K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
302 |
272 |
$5K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
136 |
127 |
$5K |
| E0601 |
Continuous positive airway pressure (cpap) device |
347 |
336 |
$4K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
407 |
402 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
277 |
258 |
$3K |
| B9998 |
Noc for enteral supplies |
116 |
67 |
$2K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
40 |
40 |
$2K |
| A7525 |
Tracheostomy mask, each |
376 |
336 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
484 |
464 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
48 |
48 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
46 |
38 |
$2K |
| A4618 |
Breathing circuits |
116 |
99 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
43 |
42 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
348 |
334 |
$1K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
14 |
13 |
$1K |
| K0006 |
Heavy duty wheelchair |
26 |
24 |
$1K |
| E1399 |
Durable medical equipment, miscellaneous |
1,193 |
555 |
$1K |
| S8186 |
Swivel adapter |
119 |
119 |
$1K |
| A4657 |
Syringe, with or without needle, each |
716 |
655 |
$1K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
15 |
12 |
$991.49 |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
26 |
24 |
$418.15 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
14 |
12 |
$397.05 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
40 |
38 |
$250.28 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
353 |
337 |
$228.79 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$228.29 |
| A4332 |
Lubricant, individual sterile packet, each |
12 |
12 |
$126.81 |
| A4649 |
Surgical supply; miscellaneous |
13 |
12 |
$32.83 |
| A4554 |
Disposable underpads, all sizes |
16 |
13 |
$0.00 |
| A9270 |
Non-covered item or service |
118 |
116 |
$0.00 |