| 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 |
2,494 |
497 |
$152K |
| B9002 |
Enteral nutrition infusion pump, any type |
490 |
280 |
$66K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,546 |
636 |
$57K |
| B9998 |
Noc for enteral supplies |
2,568 |
538 |
$54K |
| 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 |
2,533 |
494 |
$36K |
| 99601 |
|
895 |
305 |
$15K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
530 |
84 |
$14K |
| 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 |
803 |
258 |
$11K |
| 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 |
459 |
61 |
$5K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
83 |
12 |
$3K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
61 |
12 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
307 |
115 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
261 |
119 |
$2K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
318 |
70 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
792 |
329 |
$613.27 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
200 |
45 |
$575.80 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
208 |
39 |
$499.66 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
324 |
113 |
$348.89 |
| A4657 |
Syringe, with or without needle, each |
765 |
294 |
$320.81 |
| A4217 |
Sterile water/saline, 500 ml |
138 |
26 |
$156.98 |
| A4245 |
Alcohol wipes, per box |
197 |
56 |
$127.58 |
| A4649 |
Surgical supply; miscellaneous |
64 |
14 |
$0.00 |