| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
7,371 |
7,196 |
$1.37M |
| E0791 |
Parenteral infusion pump, stationary, single or multi-channel |
2,675 |
2,590 |
$444K |
| B9999 |
Noc for parenteral supplies |
23,597 |
6,276 |
$430K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
34,297 |
8,084 |
$240K |
| B4224 |
Parenteral nutrition administration kit, per day |
3,622 |
951 |
$182K |
| B4193 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix |
769 |
257 |
$94K |
| B4189 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix |
1,770 |
498 |
$92K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
3,599 |
950 |
$61K |
| S1015 |
Iv tubing extension set |
9,332 |
2,691 |
$54K |
| 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 |
877 |
836 |
$51K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,245 |
1,173 |
$31K |
| 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 |
615 |
599 |
$30K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
423 |
382 |
$30K |
| J3490 |
Unclassified drugs |
3,613 |
971 |
$29K |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
1,741 |
464 |
$27K |
| 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 |
657 |
639 |
$19K |
| E0776 |
Iv pole |
1,984 |
1,900 |
$16K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,601 |
1,591 |
$9K |
| B4197 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix |
33 |
12 |
$395.75 |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
73 |
15 |
$81.48 |
| A4245 |
Alcohol wipes, per box |
646 |
263 |
$72.82 |