| 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 |
78 |
71 |
$67K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
272 |
211 |
$67K |
| 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 |
54 |
50 |
$43K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
48 |
30 |
$35K |
| 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 |
92 |
89 |
$28K |
| E0570 |
Nebulizer, with compressor |
184 |
184 |
$15K |
| B9998 |
Noc for enteral supplies |
87 |
82 |
$14K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
125 |
125 |
$11K |
| B9002 |
Enteral nutrition infusion pump, any type |
79 |
79 |
$8K |
| E0601 |
Continuous positive airway pressure (cpap) device |
137 |
137 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
47 |
46 |
$5K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
155 |
155 |
$3K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
83 |
75 |
$3K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
35 |
35 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
42 |
38 |
$2K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
35 |
31 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
135 |
135 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
67 |
66 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
42 |
41 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
124 |
124 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
72 |
71 |
$974.25 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
40 |
31 |
$757.90 |
| A7000 |
Canister, disposable, used with suction pump, each |
59 |
57 |
$684.64 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
150 |
143 |
$536.94 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
15 |
15 |
$450.36 |
| A4927 |
Gloves, non-sterile, per 100 |
37 |
32 |
$429.00 |
| A7002 |
Tubing, used with suction pump, each |
63 |
57 |
$356.07 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
154 |
150 |
$274.20 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
39 |
35 |
$273.30 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
37 |
31 |
$257.34 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
34 |
34 |
$236.97 |
| A7015 |
Aerosol mask, used with dme nebulizer |
204 |
200 |
$204.40 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
32 |
32 |
$140.41 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
15 |
13 |
$139.20 |
| A7525 |
Tracheostomy mask, each |
14 |
13 |
$42.47 |