| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
72,141 |
70,130 |
$3.91M |
| 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 |
8,242 |
7,467 |
$3.29M |
| 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 |
18,872 |
15,169 |
$2.32M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
9,816 |
9,766 |
$1.92M |
| 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 |
4,692 |
3,956 |
$1.44M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
14,554 |
13,970 |
$1.30M |
| E1399 |
Durable medical equipment, miscellaneous |
1,102 |
895 |
$1.29M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,788 |
1,742 |
$1.18M |
| A7030 |
Full face mask used with positive airway pressure device, each |
16,632 |
16,333 |
$1.16M |
| E0202 |
Phototherapy (bilirubin) light with photometer |
2,494 |
2,250 |
$1.05M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12,397 |
11,882 |
$968K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,132 |
8,713 |
$839K |
| E0601 |
Continuous positive airway pressure (cpap) device |
23,984 |
23,485 |
$818K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
7,702 |
6,701 |
$758K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
19,409 |
18,179 |
$744K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
23,977 |
23,598 |
$713K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,577 |
5,989 |
$709K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
985 |
957 |
$567K |
| 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 |
7,568 |
5,801 |
$554K |
| T4541 |
Incontinence product, disposable underpad, large, each |
24,906 |
23,547 |
$536K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,997 |
5,727 |
$500K |
| A7031 |
Face mask interface, replacement for full face mask, each |
17,562 |
17,266 |
$483K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
7,118 |
6,605 |
$480K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,309 |
1,141 |
$476K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,739 |
2,533 |
$465K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
9,981 |
9,794 |
$463K |
| 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 |
4,038 |
3,167 |
$460K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
9,430 |
9,039 |
$453K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,980 |
4,718 |
$446K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
36,323 |
35,200 |
$435K |
| A4927 |
Gloves, non-sterile, per 100 |
34,584 |
31,205 |
$423K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,365 |
7,235 |
$408K |
| 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) |
2,016 |
1,926 |
$377K |
| E0570 |
Nebulizer, with compressor |
38,759 |
37,753 |
$376K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,098 |
3,801 |
$292K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,802 |
3,618 |
$288K |
| 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) |
3,938 |
3,849 |
$269K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,955 |
3,811 |
$263K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,291 |
941 |
$250K |
| E1392 |
Portable oxygen concentrator, rental |
12,260 |
11,864 |
$247K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,271 |
2,225 |
$244K |
| A7035 |
Headgear used with positive airway pressure device |
16,963 |
16,663 |
$244K |
| A4217 |
Sterile water/saline, 500 ml |
3,320 |
2,797 |
$237K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,273 |
2,172 |
$220K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
8,478 |
8,218 |
$216K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
7,380 |
7,189 |
$202K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
3,011 |
2,984 |
$189K |
| A4322 |
Irrigation syringe, bulb or piston, each |
6,366 |
5,911 |
$180K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,563 |
3,355 |
$177K |
| 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 |
1,289 |
1,030 |
$168K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,898 |
3,777 |
$156K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
4,682 |
4,580 |
$152K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,483 |
2,280 |
$145K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,751 |
1,607 |
$145K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,664 |
1,280 |
$135K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,285 |
1,170 |
$134K |
| 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 |
406 |
337 |
$134K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
34,549 |
33,878 |
$131K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,677 |
2,599 |
$131K |
| K0001 |
Standard wheelchair |
8,762 |
8,551 |
$124K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,507 |
1,825 |
$118K |
| 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 |
1,214 |
1,140 |
$109K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
879 |
875 |
$108K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,341 |
2,181 |
$106K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,524 |
3,320 |
$105K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
7,160 |
7,014 |
$103K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
10,923 |
10,689 |
$99K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
9,497 |
9,066 |
$95K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,365 |
1,188 |
$94K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,180 |
1,095 |
$84K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
456 |
438 |
$84K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,171 |
1,050 |
$84K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
986 |
903 |
$81K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,090 |
1,632 |
$80K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,674 |
1,555 |
$74K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,785 |
1,625 |
$68K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
655 |
483 |
$68K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,769 |
1,652 |
$67K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,757 |
1,287 |
$65K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,868 |
2,808 |
$61K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,503 |
1,492 |
$60K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,915 |
1,411 |
$58K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
3,398 |
3,290 |
$56K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,722 |
3,532 |
$54K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,198 |
1,045 |
$53K |
| A4623 |
Tracheostomy, inner cannula |
486 |
436 |
$50K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,248 |
1,138 |
$50K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
807 |
596 |
$50K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
1,164 |
1,102 |
$47K |
| 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 |
772 |
667 |
$45K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
2,672 |
2,645 |
$44K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
2,610 |
2,546 |
$44K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,617 |
1,354 |
$43K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,246 |
2,131 |
$43K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,391 |
1,549 |
$42K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
194 |
193 |
$41K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,029 |
997 |
$41K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,906 |
5,280 |
$36K |
| B9998 |
Noc for enteral supplies |
1,755 |
1,588 |
$35K |
| A4670 |
Automatic blood pressure monitor |
581 |
573 |
$31K |
| K0007 |
Extra heavy duty wheelchair |
486 |
482 |
$31K |
| B4100 |
Food thickener, administered orally, per ounce |
842 |
768 |
$30K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
566 |
539 |
$30K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
509 |
474 |
$30K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
350 |
305 |
$29K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
477 |
454 |
$28K |
| A4618 |
Breathing circuits |
1,615 |
1,454 |
$27K |
| A7002 |
Tubing, used with suction pump, each |
3,821 |
3,586 |
$27K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,213 |
3,738 |
$26K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
425 |
412 |
$26K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,565 |
1,414 |
$23K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,406 |
2,339 |
$23K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,376 |
3,165 |
$22K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
462 |
311 |
$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 |
212 |
209 |
$22K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
895 |
844 |
$21K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
621 |
582 |
$21K |
| 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 |
136 |
121 |
$21K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,081 |
2,692 |
$21K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
4,292 |
4,232 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
1,778 |
1,726 |
$21K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
132 |
125 |
$20K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,415 |
3,049 |
$20K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
313 |
297 |
$20K |
| E0776 |
Iv pole |
2,488 |
2,402 |
$18K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,687 |
3,335 |
$17K |
| A4402 |
Lubricant, per ounce |
4,286 |
3,834 |
$16K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
643 |
572 |
$16K |
| K0004 |
High strength, lightweight wheelchair |
458 |
448 |
$16K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,299 |
1,220 |
$16K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,996 |
1,775 |
$15K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
485 |
457 |
$15K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
883 |
690 |
$15K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
578 |
557 |
$15K |
| E0156 |
Seat attachment, walker |
1,618 |
1,584 |
$14K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
249 |
200 |
$13K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,064 |
1,839 |
$13K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,573 |
1,543 |
$12K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,217 |
1,158 |
$12K |
| K0003 |
Lightweight wheelchair |
461 |
459 |
$11K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,901 |
1,738 |
$10K |
| E1372 |
Immersion external heater for nebulizer |
700 |
669 |
$8K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
777 |
752 |
$8K |
| E0245 |
Tub stool or bench |
127 |
126 |
$8K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,742 |
1,577 |
$8K |
| A4332 |
Lubricant, individual sterile packet, each |
898 |
840 |
$7K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
12 |
12 |
$7K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
281 |
278 |
$7K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,264 |
1,145 |
$6K |
| A6260 |
Wound cleansers, any type, any size |
1,118 |
1,011 |
$6K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
1,831 |
1,685 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,401 |
3,259 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,967 |
3,916 |
$5K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
25 |
25 |
$5K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
218 |
208 |
$5K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
96 |
84 |
$5K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
92 |
89 |
$5K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
108 |
106 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
319 |
317 |
$5K |
| E2622 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, any depth |
25 |
25 |
$4K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
125 |
123 |
$4K |
| A4371 |
Ostomy skin barrier, powder, per oz |
846 |
811 |
$4K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
83 |
62 |
$3K |
| 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 |
198 |
170 |
$3K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
140 |
127 |
$3K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
91 |
90 |
$3K |
| K0040 |
Adjustable angle footplate, each |
49 |
36 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,516 |
1,409 |
$2K |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
797 |
681 |
$2K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
53 |
53 |
$2K |
| A4367 |
Ostomy belt, each |
378 |
369 |
$2K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
54 |
52 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
138 |
132 |
$2K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
355 |
277 |
$2K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
116 |
100 |
$1K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50 |
49 |
$1K |
| E0277 |
Powered pressure-reducing air mattress |
12 |
12 |
$1K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
23 |
13 |
$914.04 |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
13 |
13 |
$857.64 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
146 |
133 |
$794.31 |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
26 |
14 |
$727.52 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
37 |
26 |
$678.94 |
| A7012 |
Water collection device, used with large volume nebulizer |
143 |
128 |
$628.39 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
71 |
65 |
$559.61 |
| A4245 |
Alcohol wipes, per box |
198 |
185 |
$540.14 |
| E0244 |
Raised toilet seat |
19 |
19 |
$521.17 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
292 |
267 |
$479.15 |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
19 |
13 |
$437.91 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
766 |
481 |
$415.84 |
| A4616 |
Tubing (oxygen), per foot |
91 |
73 |
$315.69 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
39 |
39 |
$287.91 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
12 |
12 |
$61.59 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
14 |
13 |
$13.20 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
112 |
100 |
$0.00 |