| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Continuous positive airway pressure (cpap) device |
4,328 |
4,044 |
$242K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,694 |
1,503 |
$182K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,033 |
2,660 |
$146K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
463 |
407 |
$90K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,498 |
861 |
$68K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
683 |
308 |
$61K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,192 |
1,054 |
$60K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
960 |
873 |
$49K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,695 |
5,024 |
$44K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,082 |
949 |
$43K |
| A7035 |
Headgear used with positive airway pressure device |
1,635 |
1,482 |
$37K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
240 |
228 |
$35K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
626 |
579 |
$34K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
703 |
622 |
$23K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
108 |
91 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
771 |
690 |
$9K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
364 |
307 |
$8K |
| K0040 |
Adjustable angle footplate, each |
82 |
69 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
1,251 |
1,177 |
$5K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
47 |
27 |
$5K |
| E1392 |
Portable oxygen concentrator, rental |
214 |
204 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
77 |
65 |
$4K |
| 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) |
16 |
12 |
$2K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
28 |
24 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
29 |
26 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
72 |
59 |
$1K |
| E0570 |
Nebulizer, with compressor |
26 |
25 |
$434.79 |