| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
423 |
400 |
$65K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
8,032 |
7,320 |
$48K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
230 |
224 |
$35K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
9,676 |
8,303 |
$28K |
| B4100 |
Food thickener, administered orally, per ounce |
376 |
346 |
$27K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
4,590 |
4,052 |
$9K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
109 |
107 |
$8K |
| J7500 |
Azathioprine, oral, 50 mg |
1,073 |
988 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,079 |
1,069 |
$3K |
| 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 |
26 |
25 |
$3K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
12,330 |
11,094 |
$2K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
17,347 |
11,343 |
$2K |
| A4215 |
Needle, sterile, any size, each |
41 |
38 |
$2K |
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
75 |
37 |
$1K |
| J7515 |
Cyclosporine, oral, 25 mg |
107 |
92 |
$913.69 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
5,152 |
4,563 |
$578.51 |
| A4259 |
Lancets, per box of 100 |
241 |
236 |
$388.97 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
14 |
14 |
$6.60 |
| Q0510 |
Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant |
21 |
17 |
$0.00 |
| J7508 |
Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg |
92 |
55 |
$0.00 |