| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
5,270 |
5,142 |
$4.51M |
| E0570 |
Nebulizer, with compressor |
45,462 |
45,257 |
$4.47M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
16,613 |
14,977 |
$4.41M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
4,999 |
4,450 |
$4.12M |
| B9998 |
Noc for enteral supplies |
23,235 |
17,021 |
$2.90M |
| 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 |
6,536 |
6,394 |
$2.03M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,087 |
11,919 |
$1.49M |
| 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 |
3,491 |
3,398 |
$1.44M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
13,258 |
9,905 |
$1.14M |
| 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 |
633 |
606 |
$1.00M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,088 |
1,052 |
$859K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
51,132 |
50,693 |
$838K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
5,866 |
5,258 |
$801K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,465 |
1,333 |
$765K |
| A4554 |
Disposable underpads, all sizes |
23,932 |
22,960 |
$745K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
1,986 |
1,935 |
$745K |
| 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 |
2,745 |
2,620 |
$742K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,996 |
2,891 |
$709K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
28,519 |
27,955 |
$687K |
| 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 |
2,058 |
1,943 |
$687K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
29,084 |
28,487 |
$673K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,576 |
6,163 |
$563K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,591 |
2,894 |
$541K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,145 |
4,902 |
$506K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
5,134 |
4,849 |
$502K |
| A4605 |
Tracheal suction catheter, closed system, each |
3,312 |
2,938 |
$459K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,668 |
2,620 |
$431K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,275 |
4,234 |
$420K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,008 |
3,893 |
$397K |
| A7000 |
Canister, disposable, used with suction pump, each |
13,744 |
12,531 |
$340K |
| 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 |
782 |
755 |
$339K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,539 |
1,302 |
$313K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,352 |
2,265 |
$305K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,253 |
3,079 |
$303K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,087 |
4,257 |
$266K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
28,111 |
16,608 |
$257K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,453 |
11,326 |
$250K |
| A7002 |
Tubing, used with suction pump, each |
12,878 |
12,397 |
$248K |
| A7526 |
Tracheostomy tube collar/holder, each |
9,700 |
6,235 |
$234K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
12,290 |
6,810 |
$231K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
725 |
690 |
$221K |
| 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 |
726 |
708 |
$216K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,460 |
1,450 |
$211K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,747 |
1,578 |
$211K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,993 |
2,956 |
$202K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,376 |
2,014 |
$144K |
| A4335 |
Incontinence supply; miscellaneous |
26,964 |
25,648 |
$132K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,209 |
1,182 |
$130K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,244 |
1,147 |
$129K |
| A4322 |
Irrigation syringe, bulb or piston, each |
15,614 |
15,066 |
$125K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
821 |
652 |
$124K |
| A4927 |
Gloves, non-sterile, per 100 |
16,338 |
14,811 |
$110K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
299 |
291 |
$102K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
5,655 |
4,650 |
$92K |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,140 |
1,109 |
$88K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
13,640 |
12,687 |
$82K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
15,815 |
13,673 |
$71K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
732 |
563 |
$67K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,871 |
3,827 |
$65K |
| A7015 |
Aerosol mask, used with dme nebulizer |
56,058 |
55,295 |
$65K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
191 |
158 |
$57K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
871 |
817 |
$53K |
| A4217 |
Sterile water/saline, 500 ml |
2,255 |
1,555 |
$43K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
323 |
285 |
$39K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,832 |
1,693 |
$36K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
278 |
270 |
$32K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
10,022 |
9,525 |
$31K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
48,851 |
48,531 |
$25K |
| 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 |
27 |
27 |
$23K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
283 |
281 |
$23K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
177 |
171 |
$23K |
| E0776 |
Iv pole |
2,743 |
2,697 |
$21K |
| A4402 |
Lubricant, per ounce |
3,644 |
3,435 |
$20K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
911 |
856 |
$17K |
| A4623 |
Tracheostomy, inner cannula |
387 |
355 |
$17K |
| 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) |
87 |
87 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
657 |
640 |
$14K |
| A7525 |
Tracheostomy mask, each |
4,209 |
3,389 |
$14K |
| K0003 |
Lightweight wheelchair |
467 |
445 |
$12K |
| E0481 |
Intrapulmonary percussive ventilation system and related accessories |
39 |
36 |
$12K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
707 |
525 |
$11K |
| A4481 |
Tracheostoma filter, any type, any size, each |
1,191 |
841 |
$11K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
6,267 |
5,731 |
$10K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
612 |
454 |
$10K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
39 |
37 |
$9K |
| S8999 |
Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
69 |
64 |
$8K |
| A4670 |
Automatic blood pressure monitor |
234 |
233 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
114 |
113 |
$8K |
| B4100 |
Food thickener, administered orally, per ounce |
92 |
88 |
$8K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
311 |
305 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
352 |
242 |
$5K |
| A4245 |
Alcohol wipes, per box |
2,079 |
1,997 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
342 |
301 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
450 |
448 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
94 |
91 |
$2K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
65 |
64 |
$2K |
| L8501 |
Tracheostomy speaking valve |
25 |
25 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
12 |
12 |
$591.55 |
| A4456 |
Adhesive remover, wipes, any type, each |
67 |
24 |
$510.22 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
63 |
63 |
$422.06 |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
24 |
24 |
$347.84 |
| K0001 |
Standard wheelchair |
15 |
14 |
$261.68 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
16 |
12 |
$67.75 |
| A4244 |
Alcohol or peroxide, per pint |
16 |
15 |
$11.90 |