| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item, nos, each |
173,342 |
150,491 |
$18.89M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
356,458 |
317,258 |
$17.21M |
| A4554 |
Disposable underpads, all sizes |
571,503 |
540,333 |
$16.19M |
| A4335 |
Incontinence supply; miscellaneous |
612,963 |
500,208 |
$14.81M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
326,106 |
291,326 |
$14.39M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
622,541 |
576,772 |
$12.90M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
202,118 |
177,138 |
$12.12M |
| T4541 |
Incontinence product, disposable underpad, large, each |
472,964 |
373,135 |
$11.79M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
256,625 |
235,115 |
$11.72M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
179,908 |
161,369 |
$10.55M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
261,660 |
240,252 |
$9.53M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
83,474 |
72,779 |
$8.47M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
116,850 |
104,932 |
$7.40M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
71,790 |
61,987 |
$6.51M |
| A4927 |
Gloves, non-sterile, per 100 |
785,419 |
692,758 |
$5.52M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
179,125 |
157,879 |
$4.29M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
62,055 |
55,785 |
$3.12M |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
5,450 |
5,149 |
$3.11M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
34,531 |
30,911 |
$3.08M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
49,920 |
46,609 |
$2.29M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
22,456 |
19,382 |
$1.83M |
| 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 |
46,112 |
41,273 |
$1.76M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
38,642 |
34,953 |
$1.59M |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
38,881 |
34,655 |
$1.52M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
4,069 |
3,371 |
$1.28M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
57,193 |
42,043 |
$1.27M |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
3,748 |
3,489 |
$1.25M |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
20,124 |
18,270 |
$1.23M |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
9,931 |
8,214 |
$1.18M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
18,764 |
15,298 |
$1.09M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
98,251 |
88,674 |
$1.09M |
| 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 |
24,416 |
18,501 |
$911K |
| A6252 |
Specialty absorptive 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 |
19,495 |
15,891 |
$844K |
| 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 |
15,176 |
13,440 |
$843K |
| A4670 |
Automatic blood pressure monitor |
25,549 |
24,506 |
$829K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
23,532 |
20,684 |
$817K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
21,459 |
18,825 |
$811K |
| A5120 |
Skin barrier, wipes or swabs, each |
87,589 |
76,338 |
$780K |
| 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 |
7,642 |
6,090 |
$677K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
6,815 |
5,629 |
$607K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
9,879 |
8,820 |
$582K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
11,428 |
9,886 |
$500K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
18,150 |
15,968 |
$457K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,775 |
1,517 |
$427K |
| 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 |
3,280 |
2,810 |
$416K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
3,735 |
3,086 |
$396K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
19,843 |
16,920 |
$384K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
9,350 |
8,793 |
$379K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
11,486 |
10,108 |
$374K |
| A4452 |
Tape, waterproof, per 18 square inches |
30,021 |
25,673 |
$347K |
| 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 |
2,979 |
2,453 |
$340K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,134 |
1,917 |
$328K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
2,295 |
1,992 |
$326K |
| E1399 |
Durable medical equipment, miscellaneous |
34,650 |
33,031 |
$321K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
16,202 |
14,250 |
$307K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
5,167 |
4,263 |
$299K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
21,187 |
19,596 |
$284K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
39,262 |
34,426 |
$277K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
11,699 |
10,358 |
$270K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
3,499 |
3,365 |
$260K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
35,256 |
30,819 |
$246K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,265 |
4,509 |
$245K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,972 |
3,681 |
$232K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
16,634 |
14,197 |
$228K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
30,817 |
26,510 |
$220K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
4,454 |
4,053 |
$198K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,251 |
2,020 |
$196K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
5,835 |
5,080 |
$190K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
6,418 |
5,627 |
$179K |
| A4245 |
Alcohol wipes, per box |
23,476 |
21,310 |
$178K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
2,985 |
2,579 |
$169K |
| B4100 |
Food thickener, administered orally, per ounce |
4,168 |
3,340 |
$164K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
4,063 |
3,608 |
$153K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
9,145 |
7,460 |
$153K |
| K0004 |
High strength, lightweight wheelchair |
434 |
358 |
$141K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
5,061 |
4,313 |
$139K |
| A6260 |
Wound cleansers, any type, any size |
16,315 |
14,050 |
$138K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
7,560 |
7,468 |
$137K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
20,336 |
18,071 |
$132K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
5,947 |
5,127 |
$130K |
| A4402 |
Lubricant, per ounce |
20,695 |
19,489 |
$119K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
2,168 |
2,055 |
$118K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
3,199 |
2,955 |
$116K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
3,324 |
2,803 |
$112K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
14,457 |
12,896 |
$112K |
| A6198 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing |
855 |
619 |
$112K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
825 |
741 |
$110K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
2,284 |
1,954 |
$109K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
2,079 |
1,794 |
$107K |
| A4456 |
Adhesive remover, wipes, any type, each |
18,993 |
17,210 |
$102K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
6,269 |
4,987 |
$101K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
5,091 |
4,483 |
$100K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,233 |
2,952 |
$99K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
13,192 |
11,646 |
$98K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,453 |
1,181 |
$97K |
| K0001 |
Standard wheelchair |
492 |
422 |
$96K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
2,355 |
2,065 |
$96K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
1,828 |
1,566 |
$94K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,370 |
1,185 |
$93K |
| A9153 |
Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified |
4,820 |
4,667 |
$93K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,036 |
2,720 |
$91K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,003 |
1,788 |
$91K |
| A9150 |
Non-prescription drugs |
7,523 |
7,114 |
$90K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
2,708 |
2,464 |
$90K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
4,470 |
3,830 |
$89K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
1,104 |
899 |
$85K |
| A4217 |
Sterile water/saline, 500 ml |
9,303 |
8,399 |
$83K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
705 |
540 |
$80K |
| E0244 |
Raised toilet seat |
3,751 |
3,531 |
$80K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
5,701 |
4,983 |
$79K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,248 |
1,891 |
$78K |
| E0156 |
Seat attachment, walker |
9,093 |
8,449 |
$77K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
2,317 |
2,072 |
$76K |
| E0241 |
Bath tub wall rail, each |
3,907 |
3,707 |
$75K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,717 |
3,993 |
$75K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
13,608 |
11,917 |
$74K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
2,062 |
1,842 |
$74K |
| E0245 |
Tub stool or bench |
3,060 |
2,970 |
$73K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,365 |
1,246 |
$72K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
3,191 |
3,046 |
$72K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
899 |
827 |
$71K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
1,402 |
1,272 |
$71K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
7,600 |
6,520 |
$69K |
| A4623 |
Tracheostomy, inner cannula |
1,589 |
1,258 |
$67K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,127 |
1,706 |
$67K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,643 |
1,313 |
$66K |
| A4930 |
Gloves, sterile, per pair |
3,204 |
2,653 |
$66K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
6,234 |
5,078 |
$60K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
1,129 |
1,035 |
$59K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
3,788 |
3,353 |
$57K |
| B9998 |
Noc for enteral supplies |
774 |
579 |
$56K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
1,552 |
1,261 |
$55K |
| A4332 |
Lubricant, individual sterile packet, each |
8,821 |
7,200 |
$53K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,480 |
1,080 |
$53K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
8,444 |
7,139 |
$48K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,168 |
1,020 |
$45K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
1,598 |
1,404 |
$44K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
4,868 |
4,673 |
$42K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
2,178 |
1,905 |
$42K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
3,086 |
2,749 |
$42K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
840 |
706 |
$41K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,162 |
929 |
$40K |
| 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 |
485 |
426 |
$39K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
1,801 |
1,592 |
$38K |
| E0215 |
Electric heat pad, moist |
1,596 |
1,536 |
$37K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
823 |
681 |
$36K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,530 |
1,207 |
$34K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
5,509 |
4,714 |
$33K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
1,937 |
1,608 |
$33K |
| A4259 |
Lancets, per box of 100 |
15,162 |
14,375 |
$32K |
| E1639 |
Scale, each |
1,342 |
1,220 |
$31K |
| A6413 |
Adhesive bandage, first-aid type, any size, each |
3,083 |
3,005 |
$30K |
| E0570 |
Nebulizer, with compressor |
1,364 |
1,331 |
$30K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
892 |
779 |
$30K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,022 |
882 |
$30K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
921 |
773 |
$30K |
| A4371 |
Ostomy skin barrier, powder, per oz |
11,661 |
10,642 |
$30K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
606 |
545 |
$30K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
1,085 |
984 |
$30K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
1,225 |
1,160 |
$28K |
| A4215 |
Needle, sterile, any size, each |
2,125 |
2,065 |
$28K |
| E0607 |
Home blood glucose monitor |
2,077 |
1,818 |
$26K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
13,717 |
13,520 |
$26K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
738 |
628 |
$25K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
2,339 |
2,060 |
$25K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
2,309 |
1,828 |
$25K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
380 |
339 |
$25K |
| A6235 |
Hydrocolloid 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 |
300 |
245 |
$24K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
4,904 |
4,189 |
$23K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
7,147 |
6,365 |
$22K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
184 |
167 |
$21K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
757 |
699 |
$21K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
2,544 |
2,252 |
$20K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
1,638 |
1,431 |
$19K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
646 |
507 |
$19K |
| A4367 |
Ostomy belt, each |
4,969 |
4,594 |
$18K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
928 |
829 |
$18K |
| E0315 |
Bed accessory: board, table, or support device, any type |
557 |
527 |
$18K |
| E2100 |
Blood glucose monitor with integrated voice synthesizer |
512 |
510 |
$16K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
507 |
455 |
$14K |
| A9281 |
Reaching/grabbing device, any type, any length, each |
1,439 |
1,344 |
$14K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
748 |
709 |
$12K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
560 |
506 |
$12K |
| A4649 |
Surgical supply; miscellaneous |
545 |
402 |
$12K |
| S8490 |
Insulin syringes (100 syringes, any size) |
2,243 |
2,123 |
$12K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
714 |
646 |
$11K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
483 |
430 |
$11K |
| E0243 |
Toilet rail, each |
406 |
383 |
$10K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
152 |
144 |
$10K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
596 |
534 |
$9K |
| E0325 |
Urinal; male, jug-type, any material |
2,808 |
2,555 |
$9K |
| A4663 |
Blood pressure cuff only |
1,544 |
1,473 |
$9K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
329 |
299 |
$9K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
3,668 |
3,245 |
$9K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
332 |
321 |
$8K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
1,750 |
1,572 |
$8K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
557 |
482 |
$8K |
| A7048 |
Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each |
31 |
25 |
$8K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
92 |
88 |
$8K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
2,600 |
2,265 |
$6K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
85 |
69 |
$6K |
| 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 |
54 |
37 |
$6K |
| A4354 |
Insertion tray with drainage bag but without catheter |
1,269 |
1,068 |
$6K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
2,826 |
2,449 |
$5K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
760 |
660 |
$5K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
275 |
241 |
$4K |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
624 |
543 |
$4K |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
105 |
93 |
$4K |
| A6447 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard |
135 |
118 |
$4K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
206 |
181 |
$4K |
| K0007 |
Extra heavy duty wheelchair |
14 |
12 |
$3K |
| A6154 |
Wound pouch, each |
28 |
24 |
$3K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
112 |
112 |
$3K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
352 |
340 |
$3K |
| A6204 |
Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
47 |
39 |
$3K |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
65 |
58 |
$3K |
| E0602 |
Breast pump, manual, any type |
38 |
38 |
$3K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,153 |
1,026 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
149 |
96 |
$2K |
| E0560 |
Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery |
87 |
86 |
$2K |
| A6224 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
40 |
38 |
$2K |
| A6455 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
47 |
39 |
$2K |
| E0191 |
Heel or elbow protector, each |
252 |
231 |
$2K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
44 |
39 |
$2K |
| A4246 |
Betadine or phisohex solution, per pint |
426 |
393 |
$2K |
| E0274 |
Over-bed table |
46 |
39 |
$2K |
| V5266 |
Battery for use in hearing device |
28 |
27 |
$1K |
| A6259 |
Transparent film, sterile, more than 48 sq. in., each dressing |
31 |
27 |
$1K |
| A4657 |
Syringe, with or without needle, each |
385 |
329 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,631 |
1,573 |
$1K |
| A4258 |
Spring-powered device for lancet, each |
1,523 |
1,433 |
$1K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
49 |
39 |
$1K |
| A9300 |
Exercise equipment |
24 |
13 |
$914.38 |
| A4392 |
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
14 |
12 |
$845.83 |
| A9270 |
Non-covered item or service |
9,426 |
8,040 |
$843.13 |
| E0275 |
Bed pan, standard, metal or plastic |
106 |
93 |
$832.02 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
330 |
325 |
$792.20 |
| A9273 |
Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type |
16 |
16 |
$787.84 |
| A4218 |
Sterile saline or water, metered dose dispenser, 10 ml |
55 |
55 |
$677.63 |
| A7015 |
Aerosol mask, used with dme nebulizer |
970 |
949 |
$665.80 |
| 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 |
12 |
12 |
$654.26 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
13 |
12 |
$491.89 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$443.17 |
| A4931 |
Oral thermometer, reusable, any type, each |
251 |
250 |
$347.43 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
24 |
24 |
$313.82 |
| A7000 |
Canister, disposable, used with suction pump, each |
15 |
13 |
$266.85 |
| A4363 |
Ostomy clamp, any type, replacement only, each |
81 |
74 |
$260.36 |
| A4396 |
Ostomy belt with peristomal hernia support |
13 |
13 |
$254.00 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
125 |
122 |
$233.19 |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
15 |
14 |
$92.72 |
| A4928 |
Surgical mask, per 20 |
57 |
54 |
$65.82 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
96 |
54 |
$38.40 |
| A4244 |
Alcohol or peroxide, per pint |
12 |
12 |
$13.51 |
| A4312 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
14 |
14 |
$11.53 |
| 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 |
71 |
54 |
$0.00 |