| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,832 |
2,479 |
$68K |
| 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 |
1,787 |
1,512 |
$52K |
| 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 |
94 |
84 |
$4K |
| 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 |
72 |
61 |
$1K |
| 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 |
366 |
330 |
$979.10 |
| B9002 |
Enteral nutrition infusion pump, any type |
132 |
120 |
$864.85 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
163 |
159 |
$679.80 |
| E0776 |
Iv pole |
2,066 |
2,020 |
$274.49 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
12 |
12 |
$0.00 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
24 |
24 |
$0.00 |