| 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 |
10,040 |
9,951 |
$710K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,734 |
2,659 |
$476K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,390 |
7,342 |
$399K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,278 |
1,255 |
$199K |
| E0570 |
Nebulizer, with compressor |
4,935 |
4,863 |
$144K |
| 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) |
1,156 |
1,130 |
$133K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,100 |
2,044 |
$124K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,102 |
8,026 |
$116K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
6,811 |
6,762 |
$89K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,015 |
1,985 |
$87K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,080 |
4,004 |
$64K |
| A7035 |
Headgear used with positive airway pressure device |
3,273 |
3,206 |
$61K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,130 |
1,095 |
$55K |
| A7037 |
Tubing used with positive airway pressure device |
2,332 |
2,302 |
$53K |
| K0001 |
Standard wheelchair |
2,009 |
1,977 |
$40K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
943 |
931 |
$36K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,148 |
1,128 |
$30K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
195 |
193 |
$25K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,172 |
1,146 |
$21K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
101 |
96 |
$14K |
| 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 |
129 |
119 |
$14K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
229 |
183 |
$14K |
| 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 |
141 |
120 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
652 |
645 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
363 |
358 |
$10K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,503 |
1,479 |
$10K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
829 |
819 |
$9K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
235 |
215 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
367 |
360 |
$7K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
101 |
93 |
$6K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
197 |
195 |
$6K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
38 |
38 |
$5K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
156 |
155 |
$5K |
| E0156 |
Seat attachment, walker |
697 |
674 |
$3K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
49 |
49 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
85 |
85 |
$2K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
12 |
12 |
$2K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$1K |
| A4259 |
Lancets, per box of 100 |
730 |
721 |
$1K |
| A4670 |
Automatic blood pressure monitor |
15 |
15 |
$872.20 |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
13 |
13 |
$745.97 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
14 |
14 |
$639.10 |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
12 |
12 |
$595.60 |
| A5120 |
Skin barrier, wipes or swabs, each |
120 |
116 |
$545.03 |
| A4456 |
Adhesive remover, wipes, any type, each |
165 |
162 |
$524.19 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
354 |
346 |
$454.37 |
| A7036 |
Chinstrap used with positive airway pressure device |
40 |
40 |
$350.94 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
12 |
12 |
$195.41 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$41.18 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
60 |
59 |
$0.33 |