| 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 |
5,966 |
4,971 |
$5.11M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14,170 |
13,124 |
$3.41M |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
22,432 |
18,684 |
$2.26M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,071 |
13,535 |
$2.13M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,031 |
2,948 |
$2.04M |
| 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 |
8,463 |
8,077 |
$1.98M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
10,317 |
9,300 |
$1.66M |
| B9002 |
Enteral nutrition infusion pump, any type |
16,973 |
16,558 |
$1.33M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
12,692 |
12,378 |
$1.22M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
7,785 |
7,509 |
$1.15M |
| B9998 |
Noc for enteral supplies |
15,431 |
13,160 |
$1.03M |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,393 |
5,927 |
$1.01M |
| A4554 |
Disposable underpads, all sizes |
15,904 |
15,139 |
$804K |
| 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 |
1,618 |
1,510 |
$687K |
| 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 |
772 |
722 |
$667K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
15,836 |
15,197 |
$629K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,975 |
5,693 |
$607K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
6,039 |
5,647 |
$549K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
2,618 |
2,526 |
$482K |
| 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 |
2,067 |
1,823 |
$427K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,000 |
3,796 |
$427K |
| E0618 |
Apnea monitor, without recording feature |
2,565 |
2,404 |
$357K |
| A4927 |
Gloves, non-sterile, per 100 |
19,502 |
18,389 |
$338K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,717 |
2,490 |
$327K |
| S5199 |
Personal care item, nos, each |
1,644 |
1,006 |
$307K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
6,304 |
6,118 |
$291K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,104 |
4,014 |
$290K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
24,244 |
10,608 |
$267K |
| A4217 |
Sterile water/saline, 500 ml |
5,522 |
4,153 |
$263K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
3,312 |
3,072 |
$252K |
| 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 |
902 |
843 |
$244K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
3,943 |
3,591 |
$207K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,329 |
1,271 |
$199K |
| 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) |
1,184 |
1,153 |
$195K |
| E0570 |
Nebulizer, with compressor |
1,959 |
1,900 |
$182K |
| E1399 |
Durable medical equipment, miscellaneous |
968 |
581 |
$180K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,699 |
10,152 |
$179K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
4,223 |
4,088 |
$173K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,255 |
1,159 |
$162K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,330 |
3,050 |
$143K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,870 |
3,546 |
$131K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
4,005 |
3,873 |
$122K |
| 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) |
292 |
279 |
$115K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,096 |
1,047 |
$103K |
| A7526 |
Tracheostomy tube collar/holder, each |
5,353 |
4,946 |
$97K |
| A4244 |
Alcohol or peroxide, per pint |
4,236 |
3,948 |
$91K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
115 |
112 |
$84K |
| A4245 |
Alcohol wipes, per box |
5,376 |
5,079 |
$81K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,552 |
5,412 |
$67K |
| A7525 |
Tracheostomy mask, each |
10,626 |
3,509 |
$60K |
| A7002 |
Tubing, used with suction pump, each |
8,934 |
8,352 |
$50K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,858 |
5,543 |
$50K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
617 |
346 |
$49K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
3,510 |
1,427 |
$42K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,557 |
2,347 |
$35K |
| E0776 |
Iv pole |
2,261 |
2,202 |
$27K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
143 |
138 |
$27K |
| A4332 |
Lubricant, individual sterile packet, each |
1,898 |
1,753 |
$25K |
| A7015 |
Aerosol mask, used with dme nebulizer |
6,353 |
6,034 |
$22K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
1,118 |
1,050 |
$22K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,076 |
1,954 |
$20K |
| 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 |
551 |
488 |
$18K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
738 |
359 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,450 |
1,353 |
$8K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
480 |
450 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
855 |
794 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
200 |
193 |
$5K |
| A4930 |
Gloves, sterile, per pair |
24 |
24 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
114 |
114 |
$3K |
| A4402 |
Lubricant, per ounce |
377 |
350 |
$2K |
| E0480 |
Percussor, electric or pneumatic, home model |
25 |
24 |
$907.61 |
| A4456 |
Adhesive remover, wipes, any type, each |
14 |
13 |
$142.80 |