| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
2,099 |
1,039 |
$411K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
664 |
644 |
$375K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,125 |
3,060 |
$336K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,352 |
2,323 |
$319K |
| A4554 |
Disposable underpads, all sizes |
3,404 |
3,293 |
$157K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
1,677 |
889 |
$136K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,653 |
4,601 |
$132K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
221 |
133 |
$122K |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
401 |
376 |
$89K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,804 |
859 |
$87K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
960 |
929 |
$80K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
527 |
371 |
$68K |
| A7030 |
Full face mask used with positive airway pressure device, each |
702 |
684 |
$65K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
759 |
748 |
$64K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
529 |
528 |
$62K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,609 |
1,573 |
$61K |
| 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 |
1,197 |
597 |
$59K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
910 |
884 |
$59K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,674 |
2,578 |
$58K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
618 |
592 |
$58K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
856 |
838 |
$57K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
808 |
794 |
$55K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
669 |
323 |
$55K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
238 |
173 |
$54K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
940 |
910 |
$52K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
116 |
100 |
$50K |
| 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 |
206 |
204 |
$48K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
772 |
475 |
$45K |
| 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) |
329 |
323 |
$42K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,958 |
3,899 |
$40K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
445 |
327 |
$37K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,053 |
522 |
$34K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
92 |
68 |
$33K |
| K0001 |
Standard wheelchair |
582 |
568 |
$33K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
426 |
207 |
$32K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,286 |
1,250 |
$32K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
843 |
603 |
$29K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
58 |
55 |
$29K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,214 |
1,196 |
$28K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
48 |
47 |
$26K |
| A7035 |
Headgear used with positive airway pressure device |
1,301 |
1,271 |
$26K |
| E0570 |
Nebulizer, with compressor |
268 |
268 |
$24K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
631 |
592 |
$22K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
878 |
847 |
$21K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
556 |
280 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
1,358 |
1,317 |
$18K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
106 |
101 |
$18K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
281 |
171 |
$17K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
209 |
200 |
$16K |
| 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 |
1,120 |
385 |
$15K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
289 |
278 |
$14K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
226 |
111 |
$13K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
171 |
166 |
$13K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
52 |
25 |
$12K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
227 |
175 |
$12K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
270 |
186 |
$11K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
795 |
779 |
$10K |
| K0003 |
Lightweight wheelchair |
261 |
247 |
$10K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
121 |
60 |
$8K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
76 |
76 |
$7K |
| A4927 |
Gloves, non-sterile, per 100 |
2,190 |
2,102 |
$7K |
| L0631 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 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 |
$7K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
243 |
241 |
$7K |
| E0156 |
Seat attachment, walker |
377 |
371 |
$7K |
| A7031 |
Face mask interface, replacement for full face mask, each |
104 |
104 |
$7K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
506 |
482 |
$7K |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
106 |
52 |
$6K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
51 |
45 |
$6K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
14 |
12 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
115 |
113 |
$5K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
207 |
108 |
$4K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
42 |
26 |
$4K |
| A4402 |
Lubricant, per ounce |
890 |
863 |
$4K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
145 |
86 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
380 |
377 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
347 |
343 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,292 |
1,249 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
178 |
172 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
226 |
226 |
$3K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, 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 |
110 |
39 |
$2K |
| L3995 |
Addition to upper extremity orthosis, sock, fracture or equal, each |
47 |
40 |
$2K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
22 |
12 |
$2K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
73 |
38 |
$2K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$1K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
110 |
108 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
101 |
101 |
$1K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
25 |
24 |
$1K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
30 |
25 |
$1K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
14 |
14 |
$1K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
35 |
33 |
$932.40 |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
26 |
13 |
$833.60 |
| A7000 |
Canister, disposable, used with suction pump, each |
70 |
68 |
$748.20 |
| E0241 |
Bath tub wall rail, each |
15 |
15 |
$606.37 |
| A4217 |
Sterile water/saline, 500 ml |
79 |
48 |
$451.21 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
12 |
12 |
$432.52 |
| E1399 |
Durable medical equipment, miscellaneous |
19 |
12 |
$340.02 |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
21 |
12 |
$336.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
39 |
37 |
$287.33 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
189 |
179 |
$280.50 |
| E0244 |
Raised toilet seat |
15 |
15 |
$235.06 |
| A7002 |
Tubing, used with suction pump, each |
94 |
72 |
$222.31 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
26 |
25 |
$216.96 |
| A7015 |
Aerosol mask, used with dme nebulizer |
22 |
22 |
$18.70 |
| 99080 |
|
2,466 |
1,884 |
$0.00 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
90 |
85 |
$0.00 |
| E0575 |
Nebulizer, ultrasonic, large volume |
20 |
20 |
$0.00 |