| 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 |
18,835 |
11,898 |
$7.03M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
27,758 |
22,017 |
$5.20M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,389 |
2,118 |
$1.71M |
| 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 |
8,392 |
5,611 |
$1.13M |
| 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 |
4,933 |
2,799 |
$903K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
13,618 |
12,273 |
$891K |
| E0618 |
Apnea monitor, without recording feature |
2,122 |
1,965 |
$411K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,291 |
4,881 |
$363K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
4,121 |
3,588 |
$271K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,445 |
2,000 |
$243K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,770 |
12,391 |
$212K |
| 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 |
477 |
296 |
$156K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,487 |
2,791 |
$152K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,959 |
5,288 |
$152K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,206 |
1,800 |
$146K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,117 |
1,690 |
$138K |
| E0570 |
Nebulizer, with compressor |
1,563 |
1,437 |
$124K |
| 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 |
4,671 |
3,191 |
$117K |
| 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 |
891 |
516 |
$91K |
| A4605 |
Tracheal suction catheter, closed system, each |
822 |
659 |
$85K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,310 |
2,115 |
$70K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
1,039 |
952 |
$62K |
| 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 |
547 |
305 |
$61K |
| A7000 |
Canister, disposable, used with suction pump, each |
6,495 |
5,592 |
$56K |
| E0619 |
Apnea monitor, with recording feature |
257 |
250 |
$52K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,202 |
1,116 |
$45K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,671 |
1,393 |
$42K |
| A7030 |
Full face mask used with positive airway pressure device, each |
617 |
499 |
$38K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
6,592 |
5,487 |
$33K |
| E0776 |
Iv pole |
2,584 |
2,388 |
$27K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,744 |
2,517 |
$26K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,469 |
1,162 |
$26K |
| A7002 |
Tubing, used with suction pump, each |
6,005 |
5,131 |
$25K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
943 |
748 |
$24K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,568 |
1,096 |
$24K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,141 |
858 |
$22K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,237 |
2,008 |
$21K |
| A4481 |
Tracheostoma filter, any type, any size, each |
2,553 |
2,075 |
$20K |
| A4217 |
Sterile water/saline, 500 ml |
280 |
242 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
1,834 |
1,456 |
$14K |
| S8189 |
Tracheostomy supply, not otherwise classified |
1,110 |
528 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,164 |
2,581 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,339 |
1,814 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,085 |
855 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
412 |
321 |
$5K |
| A4402 |
Lubricant, per ounce |
2,342 |
1,917 |
$5K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,521 |
1,085 |
$4K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
4,917 |
4,161 |
$3K |
| A4657 |
Syringe, with or without needle, each |
1,859 |
1,534 |
$2K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
241 |
130 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,436 |
1,330 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
766 |
573 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
15 |
14 |
$488.28 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
731 |
399 |
$356.59 |
| A7012 |
Water collection device, used with large volume nebulizer |
138 |
129 |
$353.43 |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
47 |
42 |
$269.15 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
15 |
14 |
$157.16 |
| A4615 |
Cannula, nasal |
409 |
340 |
$23.77 |
| A4616 |
Tubing (oxygen), per foot |
783 |
581 |
$19.98 |
| E1353 |
Regulator |
132 |
126 |
$3.88 |
| A9270 |
Non-covered item or service |
95 |
60 |
$0.00 |
| 84035 |
|
39 |
38 |
$0.00 |