| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
130 |
129 |
$563K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
6,225 |
5,917 |
$165K |
| 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 |
1,211 |
874 |
$81K |
| A4245 |
Alcohol wipes, per box |
6,081 |
5,794 |
$67K |
| 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 |
849 |
824 |
$53K |
| E0671 |
Segmental gradient pressure pneumatic appliance, full leg |
130 |
129 |
$50K |
| E0670 |
Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk |
42 |
41 |
$46K |
| A4259 |
Lancets, per box of 100 |
6,222 |
5,917 |
$37K |
| A4256 |
Normal, low and high calibrator solution / chips |
6,232 |
5,925 |
$20K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
24 |
24 |
$18K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
122 |
92 |
$8K |
| E0607 |
Home blood glucose monitor |
91 |
88 |
$3K |
| A4258 |
Spring-powered device for lancet, each |
58 |
55 |
$11.02 |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
14 |
14 |
$0.00 |