| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,169 |
887 |
$452K |
| 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 |
1,428 |
1,173 |
$322K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,046 |
5,845 |
$302K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,056 |
1,544 |
$182K |
| 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 |
506 |
393 |
$103K |
| 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 |
873 |
627 |
$62K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
163 |
91 |
$60K |
| 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 |
688 |
521 |
$57K |
| 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 |
2,461 |
2,143 |
$50K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,019 |
910 |
$43K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
566 |
379 |
$34K |
| E1392 |
Portable oxygen concentrator, rental |
1,638 |
1,416 |
$31K |
| B9002 |
Enteral nutrition infusion pump, any type |
927 |
748 |
$31K |
| K0003 |
Lightweight wheelchair |
1,085 |
828 |
$29K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
426 |
357 |
$28K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
178 |
137 |
$25K |
| A7030 |
Full face mask used with positive airway pressure device, each |
596 |
460 |
$25K |
| E0570 |
Nebulizer, with compressor |
785 |
670 |
$22K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
835 |
737 |
$21K |
| A7526 |
Tracheostomy tube collar/holder, each |
694 |
430 |
$20K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
508 |
436 |
$19K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
153 |
138 |
$18K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
822 |
649 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,330 |
1,140 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
682 |
605 |
$14K |
| K0001 |
Standard wheelchair |
653 |
536 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,530 |
1,205 |
$11K |
| E0619 |
Apnea monitor, with recording feature |
77 |
72 |
$11K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
411 |
360 |
$10K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
463 |
417 |
$10K |
| 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 |
40 |
25 |
$10K |
| A7000 |
Canister, disposable, used with suction pump, each |
954 |
641 |
$9K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
379 |
309 |
$8K |
| A7031 |
Face mask interface, replacement for full face mask, each |
498 |
360 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
663 |
541 |
$6K |
| 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) |
114 |
91 |
$5K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
160 |
118 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
71 |
50 |
$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 |
56 |
50 |
$5K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
774 |
501 |
$4K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
202 |
181 |
$4K |
| A7002 |
Tubing, used with suction pump, each |
923 |
617 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
102 |
79 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
58 |
49 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,058 |
805 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
992 |
781 |
$1K |
| A4623 |
Tracheostomy, inner cannula |
18 |
13 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
48 |
24 |
$900.61 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
12 |
12 |
$466.48 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
120 |
87 |
$464.32 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
65 |
37 |
$409.44 |
| E0245 |
Tub stool or bench |
15 |
12 |
$344.40 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
16 |
12 |
$281.79 |
| A7015 |
Aerosol mask, used with dme nebulizer |
287 |
246 |
$226.10 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
222 |
204 |
$78.61 |