| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
12,666 |
9,421 |
$841K |
| 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 |
4,405 |
3,401 |
$834K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
20,718 |
19,167 |
$750K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,975 |
5,011 |
$483K |
| 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 |
6,517 |
5,129 |
$433K |
| 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 |
1,799 |
1,494 |
$424K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
884 |
835 |
$266K |
| 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 |
945 |
658 |
$263K |
| 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 |
2,740 |
2,080 |
$257K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,471 |
2,080 |
$93K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,738 |
6,246 |
$90K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,454 |
1,377 |
$69K |
| 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 |
941 |
556 |
$65K |
| B9998 |
Noc for enteral supplies |
1,094 |
980 |
$61K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,031 |
901 |
$58K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,003 |
962 |
$38K |
| E1392 |
Portable oxygen concentrator, rental |
4,023 |
3,736 |
$37K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
614 |
562 |
$33K |
| 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 |
128 |
101 |
$27K |
| E0570 |
Nebulizer, with compressor |
2,084 |
1,849 |
$22K |
| 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 |
432 |
338 |
$11K |
| E0776 |
Iv pole |
1,561 |
1,469 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,353 |
2,230 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
542 |
511 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
170 |
164 |
$4K |
| A7031 |
Face mask interface, replacement for full face mask, each |
202 |
191 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
66 |
63 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
215 |
199 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
111 |
97 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
67 |
64 |
$2K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
50 |
40 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
108 |
102 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
208 |
183 |
$119.94 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
20 |
18 |
$109.45 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
18 |
17 |
$59.98 |
| A7015 |
Aerosol mask, used with dme nebulizer |
15 |
13 |
$7.73 |