| 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 |
64,806 |
43,644 |
$2.99M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,564 |
2,057 |
$1.96M |
| 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 |
1,651 |
1,260 |
$1.47M |
| E1399 |
Durable medical equipment, miscellaneous |
7,451 |
2,638 |
$1.07M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,310 |
4,456 |
$1.07M |
| B9998 |
Noc for enteral supplies |
13,964 |
6,729 |
$1.02M |
| E0601 |
Continuous positive airway pressure (cpap) device |
27,423 |
20,940 |
$851K |
| 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 |
2,323 |
1,750 |
$846K |
| 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 |
3,326 |
2,500 |
$737K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,187 |
5,410 |
$569K |
| A7030 |
Full face mask used with positive airway pressure device, each |
10,980 |
7,799 |
$524K |
| 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 |
4,792 |
2,646 |
$497K |
| 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 |
4,395 |
2,600 |
$405K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
16,603 |
11,896 |
$332K |
| E0570 |
Nebulizer, with compressor |
22,721 |
15,692 |
$327K |
| A7031 |
Face mask interface, replacement for full face mask, each |
12,497 |
8,818 |
$284K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,984 |
1,550 |
$271K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
31,057 |
21,584 |
$262K |
| 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) |
5,222 |
3,711 |
$256K |
| 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 |
844 |
434 |
$245K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
14,919 |
11,888 |
$236K |
| E1093 |
Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests |
2,533 |
2,208 |
$231K |
| E0203 |
Therapeutic lightbox, minimum 10,000 lux, table top model |
2,882 |
2,411 |
$212K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,742 |
4,896 |
$210K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,479 |
2,749 |
$208K |
| E1086 |
Hemi-wheelchair detachable arms desk or full length, swing away detachable footrests |
2,477 |
2,213 |
$205K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
4,866 |
2,911 |
$202K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
424 |
237 |
$201K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,271 |
2,566 |
$200K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,574 |
778 |
$200K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,459 |
1,777 |
$185K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,056 |
1,571 |
$180K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,912 |
2,770 |
$172K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
4,516 |
2,013 |
$161K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
4,445 |
2,496 |
$155K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,030 |
1,344 |
$152K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,074 |
1,856 |
$148K |
| A4623 |
Tracheostomy, inner cannula |
1,915 |
1,283 |
$148K |
| A7035 |
Headgear used with positive airway pressure device |
14,799 |
10,595 |
$147K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
4,115 |
2,891 |
$135K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
5,124 |
3,850 |
$128K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,916 |
5,681 |
$128K |
| E1392 |
Portable oxygen concentrator, rental |
9,698 |
6,779 |
$127K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
11,484 |
8,053 |
$125K |
| A4649 |
Surgical supply; miscellaneous |
7,038 |
4,258 |
$122K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
3,058 |
2,696 |
$121K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,672 |
3,183 |
$111K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,860 |
1,324 |
$98K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
1,342 |
785 |
$91K |
| 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 |
8,587 |
6,016 |
$90K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,386 |
1,591 |
$89K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,441 |
863 |
$89K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
4,113 |
2,285 |
$87K |
| 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 |
219 |
157 |
$80K |
| A7002 |
Tubing, used with suction pump, each |
5,613 |
3,911 |
$80K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
24,843 |
18,085 |
$75K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,056 |
702 |
$71K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
6,760 |
5,070 |
$66K |
| A7037 |
Tubing used with positive airway pressure device |
6,131 |
4,325 |
$63K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
692 |
226 |
$60K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,811 |
2,076 |
$56K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
168 |
90 |
$51K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
207 |
174 |
$50K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,061 |
766 |
$50K |
| A4618 |
Breathing circuits |
3,262 |
2,152 |
$46K |
| B9004 |
Parenteral nutrition infusion pump, portable |
203 |
149 |
$44K |
| A7000 |
Canister, disposable, used with suction pump, each |
5,199 |
3,704 |
$43K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
11,829 |
8,371 |
$41K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,200 |
913 |
$40K |
| E0245 |
Tub stool or bench |
1,195 |
951 |
$32K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
509 |
376 |
$32K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
216 |
169 |
$32K |
| A4670 |
Automatic blood pressure monitor |
705 |
631 |
$31K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
2,698 |
1,750 |
$29K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
752 |
445 |
$24K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
820 |
508 |
$24K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,293 |
753 |
$23K |
| E0184 |
Dry pressure mattress |
1,685 |
1,047 |
$20K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
2,525 |
1,097 |
$19K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
364 |
264 |
$17K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,149 |
1,579 |
$16K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
893 |
617 |
$16K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
2,530 |
1,141 |
$16K |
| A4452 |
Tape, waterproof, per 18 square inches |
564 |
418 |
$16K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
274 |
221 |
$13K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
47 |
38 |
$11K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
325 |
187 |
$11K |
| E0776 |
Iv pole |
1,847 |
1,184 |
$11K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
124 |
88 |
$11K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
347 |
299 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,272 |
5,165 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
756 |
621 |
$9K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,171 |
1,591 |
$9K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
17 |
13 |
$9K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
233 |
155 |
$9K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
41 |
37 |
$9K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
85 |
43 |
$7K |
| E1092 |
Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests |
111 |
105 |
$7K |
| E0156 |
Seat attachment, walker |
1,276 |
821 |
$6K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
14 |
12 |
$6K |
| E1084 |
Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests |
93 |
87 |
$6K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
177 |
129 |
$5K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
243 |
154 |
$5K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
238 |
148 |
$5K |
| E0635 |
Patient lift, electric with seat or sling |
68 |
39 |
$5K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
52 |
38 |
$5K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
54 |
38 |
$4K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$4K |
| E0627 |
Seat lift mechanism, electric, any type |
23 |
15 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
118 |
71 |
$4K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
99 |
56 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,513 |
3,363 |
$3K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
18 |
18 |
$3K |
| K0001 |
Standard wheelchair |
3,439 |
2,647 |
$3K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
107 |
63 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
878 |
598 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
130 |
90 |
$3K |
| A7525 |
Tracheostomy mask, each |
1,521 |
996 |
$3K |
| K0040 |
Adjustable angle footplate, each |
46 |
24 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
916 |
705 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
439 |
284 |
$3K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
28 |
13 |
$2K |
| 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 |
146 |
98 |
$2K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
25 |
12 |
$2K |
| L8501 |
Tracheostomy speaking valve |
60 |
36 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
16 |
12 |
$2K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
77 |
60 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
214 |
117 |
$1K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
32 |
25 |
$1K |
| E0244 |
Raised toilet seat |
26 |
25 |
$1K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
20 |
13 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
393 |
260 |
$946.97 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
56 |
37 |
$886.52 |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
19 |
13 |
$709.40 |
| A4322 |
Irrigation syringe, bulb or piston, each |
208 |
129 |
$709.26 |
| A4456 |
Adhesive remover, wipes, any type, each |
122 |
85 |
$688.25 |
| E0994 |
Arm rest, each |
30 |
27 |
$600.72 |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
46 |
25 |
$584.91 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
60 |
55 |
$583.95 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
58 |
40 |
$553.00 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
279 |
215 |
$503.36 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
19 |
12 |
$368.62 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
115 |
64 |
$304.24 |
| A4244 |
Alcohol or peroxide, per pint |
119 |
100 |
$264.90 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
26 |
13 |
$247.24 |
| K0002 |
Standard hemi (low seat) wheelchair |
2,561 |
2,003 |
$237.70 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,693 |
1,275 |
$192.30 |
| K0006 |
Heavy duty wheelchair |
530 |
438 |
$120.14 |
| K0007 |
Extra heavy duty wheelchair |
175 |
141 |
$119.25 |
| A4402 |
Lubricant, per ounce |
12 |
12 |
$110.62 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
16 |
12 |
$82.69 |
| E0305 |
Bed side rails, half length |
50 |
29 |
$61.43 |
| A4332 |
Lubricant, individual sterile packet, each |
13 |
12 |
$55.98 |
| A4245 |
Alcohol wipes, per box |
14 |
12 |
$22.08 |
| A4371 |
Ostomy skin barrier, powder, per oz |
19 |
12 |
$13.34 |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
44 |
20 |
$0.00 |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
521 |
485 |
$0.00 |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
132 |
111 |
$0.00 |