| 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 |
14,673 |
13,165 |
$11.92M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
20,135 |
19,340 |
$6.59M |
| 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 |
18,261 |
15,150 |
$4.41M |
| B9998 |
Noc for enteral supplies |
44,520 |
22,353 |
$2.81M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,704 |
2,597 |
$2.64M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
18,977 |
18,426 |
$2.64M |
| 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 |
6,216 |
4,219 |
$2.09M |
| 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 |
948 |
866 |
$1.47M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,253 |
7,929 |
$1.37M |
| E1399 |
Durable medical equipment, miscellaneous |
3,057 |
2,714 |
$1.34M |
| E0570 |
Nebulizer, with compressor |
10,184 |
10,016 |
$1.21M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
10,092 |
9,772 |
$1.19M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,678 |
2,347 |
$1.18M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,467 |
5,284 |
$1.17M |
| 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 |
3,500 |
3,116 |
$1.09M |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
16,371 |
9,471 |
$1.01M |
| B9002 |
Enteral nutrition infusion pump, any type |
9,338 |
9,031 |
$946K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
7,097 |
6,793 |
$751K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
1,433 |
996 |
$640K |
| 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 |
1,903 |
1,683 |
$608K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
1,046 |
723 |
$591K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,626 |
1,530 |
$577K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
2,390 |
2,225 |
$545K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
2,183 |
2,139 |
$540K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,045 |
1,787 |
$504K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,261 |
4,097 |
$485K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
19,189 |
18,802 |
$471K |
| A4554 |
Disposable underpads, all sizes |
13,663 |
13,128 |
$466K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
14,949 |
14,624 |
$458K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
691 |
628 |
$432K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,091 |
3,084 |
$418K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
2,057 |
1,718 |
$411K |
| K0001 |
Standard wheelchair |
10,981 |
10,731 |
$408K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,948 |
2,851 |
$380K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
46,905 |
20,956 |
$370K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
342 |
327 |
$320K |
| 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 |
1,009 |
878 |
$315K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,804 |
2,687 |
$307K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,387 |
2,911 |
$306K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,776 |
1,922 |
$297K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,126 |
1,980 |
$295K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,674 |
2,601 |
$293K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,358 |
6,236 |
$286K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
2,132 |
1,507 |
$286K |
| A6260 |
Wound cleansers, any type, any size |
4,606 |
4,273 |
$282K |
| A7000 |
Canister, disposable, used with suction pump, each |
7,307 |
7,083 |
$277K |
| A4322 |
Irrigation syringe, bulb or piston, each |
15,307 |
14,472 |
$264K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,351 |
2,246 |
$254K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,471 |
1,286 |
$248K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,590 |
1,478 |
$225K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,170 |
3,890 |
$224K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,443 |
1,371 |
$215K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,755 |
1,689 |
$209K |
| B4100 |
Food thickener, administered orally, per ounce |
4,034 |
3,873 |
$208K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,763 |
1,701 |
$198K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,151 |
498 |
$188K |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
1,381 |
1,303 |
$186K |
| A4335 |
Incontinence supply; miscellaneous |
28,935 |
27,986 |
$186K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,448 |
1,388 |
$183K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
210 |
208 |
$183K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
4,680 |
4,592 |
$156K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
903 |
864 |
$153K |
| A7002 |
Tubing, used with suction pump, each |
6,889 |
6,682 |
$152K |
| E0619 |
Apnea monitor, with recording feature |
1,098 |
1,048 |
$149K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
2,119 |
1,510 |
$140K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
935 |
303 |
$138K |
| E0791 |
Parenteral infusion pump, stationary, single or multi-channel |
846 |
670 |
$131K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,088 |
1,051 |
$130K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14,198 |
12,286 |
$129K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
1,017 |
692 |
$118K |
| L2280 |
Addition to lower extremity, molded inner boot |
345 |
246 |
$117K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
228 |
212 |
$104K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
554 |
510 |
$96K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
10,094 |
6,073 |
$92K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
1,151 |
425 |
$91K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
19,670 |
19,171 |
$79K |
| A4670 |
Automatic blood pressure monitor |
1,368 |
1,353 |
$78K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
7,552 |
6,441 |
$77K |
| E0776 |
Iv pole |
9,245 |
8,942 |
$75K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,290 |
1,268 |
$74K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
326 |
303 |
$70K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,586 |
2,520 |
$69K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
766 |
514 |
$69K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
544 |
461 |
$66K |
| A4212 |
Non-coring needle or stylet with or without catheter |
1,532 |
873 |
$65K |
| L1200 |
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only |
59 |
55 |
$62K |
| L3260 |
Surgical boot/shoe, each |
2,015 |
1,946 |
$60K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
37 |
37 |
$60K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
172 |
167 |
$56K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
713 |
698 |
$53K |
| A6245 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
767 |
726 |
$49K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
992 |
936 |
$49K |
| 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) |
477 |
472 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
2,483 |
2,099 |
$43K |
| A6214 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
251 |
238 |
$40K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
319 |
253 |
$39K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,585 |
3,169 |
$39K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
628 |
616 |
$35K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
913 |
885 |
$34K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
129 |
83 |
$33K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
2,197 |
1,752 |
$32K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,184 |
1,128 |
$30K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
390 |
351 |
$28K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
3,253 |
2,084 |
$28K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,340 |
902 |
$27K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
855 |
834 |
$26K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
108 |
105 |
$26K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
322 |
312 |
$26K |
| E2617 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware |
25 |
24 |
$26K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
221 |
211 |
$24K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,199 |
2,145 |
$22K |
| A7015 |
Aerosol mask, used with dme nebulizer |
15,094 |
14,664 |
$22K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
166 |
160 |
$21K |
| E8001 |
Gait trainer, pediatric size, upright support, includes all accessories and components |
13 |
13 |
$21K |
| A4398 |
Ostomy irrigation supply; bag, each |
266 |
223 |
$20K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
109 |
109 |
$20K |
| A7037 |
Tubing used with positive airway pressure device |
811 |
777 |
$16K |
| 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 |
59 |
57 |
$15K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,711 |
1,544 |
$14K |
| A4402 |
Lubricant, per ounce |
2,536 |
2,456 |
$13K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
332 |
322 |
$13K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
130 |
124 |
$12K |
| K0040 |
Adjustable angle footplate, each |
93 |
91 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
866 |
841 |
$11K |
| L1210 |
Addition to tlso, (low profile), lateral thoracic extension |
60 |
56 |
$11K |
| A4215 |
Needle, sterile, any size, each |
3,354 |
1,638 |
$10K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
31 |
25 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
86 |
85 |
$10K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
109 |
105 |
$10K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
154 |
147 |
$10K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
130 |
124 |
$9K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
161 |
155 |
$8K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
13,931 |
13,555 |
$8K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
56 |
56 |
$8K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,595 |
1,215 |
$8K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
192 |
186 |
$7K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
116 |
111 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
92 |
92 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
823 |
792 |
$6K |
| 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 |
71 |
69 |
$6K |
| A7525 |
Tracheostomy mask, each |
1,489 |
1,447 |
$6K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
159 |
155 |
$6K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
92 |
86 |
$5K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
476 |
464 |
$5K |
| A4245 |
Alcohol wipes, per box |
2,710 |
2,232 |
$5K |
| A4565 |
Slings |
494 |
485 |
$3K |
| A4248 |
Chlorhexidine containing antiseptic, 1 ml |
1,597 |
869 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
841 |
812 |
$3K |
| K0038 |
Leg strap, each |
70 |
67 |
$3K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
14 |
12 |
$3K |
| L3332 |
Lift, elevation, inside shoe, tapered, up to one-half inch |
68 |
56 |
$3K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
802 |
733 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
343 |
331 |
$3K |
| B4082 |
Nasogastric tubing without stylet |
72 |
69 |
$2K |
| L1240 |
Addition to tlso, (low profile), lumbar derotation pad |
44 |
42 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
922 |
901 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
153 |
148 |
$1K |
| A7012 |
Water collection device, used with large volume nebulizer |
177 |
170 |
$1K |
| L8501 |
Tracheostomy speaking valve |
14 |
14 |
$970.43 |
| E0480 |
Percussor, electric or pneumatic, home model |
25 |
25 |
$860.33 |
| A4421 |
Ostomy supply; miscellaneous |
12 |
12 |
$759.00 |
| L1060 |
Addition to ctlso or scoliosis orthosis, thoracic pad |
12 |
12 |
$735.30 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
108 |
97 |
$601.17 |
| L1290 |
Addition to tlso, (low profile), lateral trochanteric pad |
13 |
12 |
$564.77 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
64 |
60 |
$559.15 |
| A4930 |
Gloves, sterile, per pair |
210 |
132 |
$529.94 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
18 |
15 |
$305.82 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
71 |
67 |
$228.57 |
| A4615 |
Cannula, nasal |
152 |
141 |
$171.72 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
64 |
64 |
$103.30 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
12 |
$81.35 |
| A4649 |
Surgical supply; miscellaneous |
13 |
13 |
$47.84 |
| A4616 |
Tubing (oxygen), per foot |
46 |
29 |
$2.15 |