| 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 |
9,483 |
9,233 |
$293K |
| 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 |
1,777 |
1,696 |
$164K |
| 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 |
2,001 |
1,907 |
$105K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,946 |
1,868 |
$102K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,212 |
3,076 |
$93K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,609 |
2,536 |
$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 |
1,216 |
1,171 |
$73K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,973 |
1,951 |
$66K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,461 |
3,417 |
$52K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,206 |
7,028 |
$48K |
| A7037 |
Tubing used with positive airway pressure device |
3,174 |
3,102 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,120 |
1,075 |
$30K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,366 |
3,304 |
$26K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,098 |
1,062 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,789 |
4,645 |
$14K |
| A7035 |
Headgear used with positive airway pressure device |
1,889 |
1,831 |
$12K |
| B9002 |
Enteral nutrition infusion pump, any type |
452 |
440 |
$9K |
| E0570 |
Nebulizer, with compressor |
2,668 |
2,547 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,450 |
1,415 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
527 |
520 |
$2K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
284 |
284 |
$1K |
| 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) |
27 |
27 |
$801.10 |
| E0776 |
Iv pole |
286 |
273 |
$598.31 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
25 |
25 |
$488.22 |
| E1392 |
Portable oxygen concentrator, rental |
91 |
91 |
$261.07 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
122 |
121 |
$218.80 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
129 |
125 |
$102.85 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
25 |
24 |
$83.72 |