| 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 |
28,369 |
25,793 |
$2.24M |
| 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 |
4,913 |
3,673 |
$2.20M |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
55,735 |
52,969 |
$2.05M |
| 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 |
10,604 |
8,881 |
$1.98M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,391 |
3,062 |
$1.59M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
25,481 |
24,566 |
$1.51M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,287 |
8,977 |
$1.30M |
| T4541 |
Incontinence product, disposable underpad, large, each |
31,786 |
30,713 |
$1.30M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,911 |
9,651 |
$1.16M |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
40,860 |
23,811 |
$1.10M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,019 |
4,162 |
$1.04M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,346 |
1,284 |
$817K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,976 |
5,609 |
$797K |
| 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 |
5,835 |
4,794 |
$769K |
| E0601 |
Continuous positive airway pressure (cpap) device |
11,860 |
10,562 |
$689K |
| 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 |
5,872 |
4,631 |
$646K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,692 |
4,534 |
$641K |
| 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 |
3,669 |
2,737 |
$576K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,597 |
5,067 |
$567K |
| A4927 |
Gloves, non-sterile, per 100 |
26,810 |
24,015 |
$566K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
8,434 |
7,305 |
$455K |
| E1392 |
Portable oxygen concentrator, rental |
14,500 |
12,948 |
$398K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
12,129 |
11,567 |
$378K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,542 |
2,209 |
$352K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,918 |
1,878 |
$347K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
8,596 |
7,714 |
$327K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,197 |
2,838 |
$320K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,887 |
2,703 |
$320K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,507 |
2,373 |
$319K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,795 |
4,314 |
$316K |
| 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) |
2,188 |
1,982 |
$301K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
41,799 |
25,303 |
$298K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,865 |
1,766 |
$283K |
| A7031 |
Face mask interface, replacement for full face mask, each |
6,871 |
6,330 |
$278K |
| K0001 |
Standard wheelchair |
9,353 |
8,094 |
$225K |
| 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 |
1,356 |
1,174 |
$203K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,345 |
991 |
$199K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,017 |
1,679 |
$189K |
| B9998 |
Noc for enteral supplies |
2,571 |
1,359 |
$184K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,472 |
1,443 |
$176K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,031 |
824 |
$173K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,849 |
6,220 |
$170K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,703 |
1,547 |
$165K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
359 |
258 |
$146K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
4,873 |
4,257 |
$139K |
| B4100 |
Food thickener, administered orally, per ounce |
848 |
687 |
$132K |
| 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 |
436 |
335 |
$131K |
| A7035 |
Headgear used with positive airway pressure device |
6,143 |
5,532 |
$130K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,745 |
2,395 |
$129K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
967 |
549 |
$117K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
951 |
814 |
$111K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,358 |
2,077 |
$104K |
| E0570 |
Nebulizer, with compressor |
7,317 |
6,304 |
$104K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,291 |
1,063 |
$97K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,533 |
13,277 |
$58K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,187 |
1,640 |
$55K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
4,468 |
3,989 |
$51K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
8,335 |
3,595 |
$51K |
| 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) |
195 |
158 |
$51K |
| A7526 |
Tracheostomy tube collar/holder, each |
767 |
623 |
$48K |
| K0003 |
Lightweight wheelchair |
1,074 |
917 |
$48K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
292 |
269 |
$47K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,145 |
728 |
$47K |
| A4217 |
Sterile water/saline, 500 ml |
1,793 |
1,227 |
$42K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,614 |
2,281 |
$39K |
| 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 |
89 |
63 |
$37K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,010 |
2,660 |
$37K |
| E0619 |
Apnea monitor, with recording feature |
105 |
80 |
$36K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,978 |
1,712 |
$35K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
257 |
223 |
$34K |
| K0006 |
Heavy duty wheelchair |
610 |
521 |
$33K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
4,850 |
4,345 |
$32K |
| K0007 |
Extra heavy duty wheelchair |
333 |
253 |
$30K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,444 |
2,880 |
$30K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,414 |
1,208 |
$30K |
| E0776 |
Iv pole |
1,188 |
1,009 |
$29K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
287 |
242 |
$29K |
| A7002 |
Tubing, used with suction pump, each |
3,342 |
2,688 |
$24K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
838 |
730 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,259 |
1,146 |
$23K |
| E0245 |
Tub stool or bench |
170 |
157 |
$20K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,059 |
879 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
906 |
845 |
$17K |
| K0002 |
Standard hemi (low seat) wheelchair |
255 |
221 |
$15K |
| E0156 |
Seat attachment, walker |
1,237 |
1,083 |
$12K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,949 |
1,347 |
$11K |
| A4670 |
Automatic blood pressure monitor |
103 |
100 |
$11K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
89 |
88 |
$11K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
348 |
221 |
$10K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
354 |
241 |
$8K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
1,552 |
1,212 |
$8K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
91 |
86 |
$8K |
| A4616 |
Tubing (oxygen), per foot |
494 |
345 |
$7K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,664 |
1,374 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
443 |
397 |
$6K |
| A4335 |
Incontinence supply; miscellaneous |
2,238 |
1,535 |
$6K |
| A4618 |
Breathing circuits |
123 |
79 |
$6K |
| A4657 |
Syringe, with or without needle, each |
612 |
502 |
$5K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
191 |
177 |
$5K |
| 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 |
71 |
63 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
496 |
347 |
$4K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
147 |
54 |
$4K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
26 |
26 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
260 |
229 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
1,942 |
805 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
938 |
558 |
$3K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
380 |
286 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,015 |
862 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
266 |
231 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
64 |
28 |
$2K |
| A4615 |
Cannula, nasal |
737 |
369 |
$1K |
| A4402 |
Lubricant, per ounce |
89 |
62 |
$894.73 |
| A7015 |
Aerosol mask, used with dme nebulizer |
940 |
822 |
$821.03 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
27 |
15 |
$816.84 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
14 |
12 |
$710.16 |
| A4332 |
Lubricant, individual sterile packet, each |
45 |
44 |
$524.96 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
89 |
84 |
$114.03 |
| A4244 |
Alcohol or peroxide, per pint |
117 |
64 |
$88.50 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
401 |
275 |
$36.48 |
| E0305 |
Bed side rails, half length |
137 |
90 |
$34.18 |
| XZERO |
|
106 |
98 |
$0.00 |