| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
502 |
301 |
$384K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,773 |
8,507 |
$353K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,557 |
2,216 |
$336K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,841 |
2,760 |
$279K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,160 |
2,097 |
$243K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,978 |
3,726 |
$234K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,968 |
3,821 |
$226K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,677 |
5,581 |
$209K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,149 |
2,059 |
$201K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,193 |
2,156 |
$186K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,808 |
2,748 |
$150K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
616 |
588 |
$121K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
826 |
808 |
$112K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
709 |
691 |
$91K |
| A7035 |
Headgear used with positive airway pressure device |
4,498 |
4,410 |
$86K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,042 |
1,942 |
$82K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
343 |
326 |
$61K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
359 |
342 |
$59K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
463 |
418 |
$54K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,609 |
1,578 |
$53K |
| E0570 |
Nebulizer, with compressor |
2,237 |
2,187 |
$53K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,023 |
1,005 |
$52K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
288 |
271 |
$45K |
| K0001 |
Standard wheelchair |
2,350 |
2,313 |
$44K |
| 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 |
1,526 |
1,497 |
$40K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
276 |
260 |
$39K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,949 |
7,767 |
$36K |
| E1392 |
Portable oxygen concentrator, rental |
1,149 |
1,115 |
$33K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
601 |
525 |
$32K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,076 |
1,049 |
$31K |
| 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) |
268 |
265 |
$27K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,090 |
2,050 |
$24K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
640 |
623 |
$22K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
424 |
412 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
764 |
700 |
$20K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
239 |
227 |
$20K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
574 |
562 |
$19K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
122 |
112 |
$19K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
169 |
165 |
$16K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
246 |
235 |
$15K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
663 |
648 |
$15K |
| 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 |
208 |
134 |
$12K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
173 |
73 |
$10K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
166 |
154 |
$10K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
59 |
57 |
$9K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
179 |
161 |
$7K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
116 |
110 |
$7K |
| K0003 |
Lightweight wheelchair |
110 |
106 |
$4K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
87 |
82 |
$4K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
114 |
109 |
$3K |
| A4670 |
Automatic blood pressure monitor |
37 |
37 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
345 |
340 |
$2K |
| E1399 |
Durable medical equipment, miscellaneous |
18 |
13 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
914 |
882 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
62 |
54 |
$2K |
| E0245 |
Tub stool or bench |
26 |
26 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
72 |
66 |
$2K |
| E0156 |
Seat attachment, walker |
76 |
75 |
$1K |
| B9998 |
Noc for enteral supplies |
21 |
12 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
75 |
74 |
$852.09 |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
14 |
12 |
$811.93 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
12 |
$682.45 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$656.85 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
28 |
28 |
$494.22 |
| A7037 |
Tubing used with positive airway pressure device |
43 |
41 |
$461.71 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
75 |
73 |
$61.93 |
| A7015 |
Aerosol mask, used with dme nebulizer |
16 |
15 |
$24.65 |