| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,836 |
2,273 |
$380K |
| 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 |
1,943 |
740 |
$53K |
| 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 |
770 |
354 |
$25K |
| A7526 |
Tracheostomy tube collar/holder, each |
756 |
687 |
$16K |
| 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 |
131 |
66 |
$13K |
| 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 |
154 |
131 |
$12K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
574 |
518 |
$3K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
114 |
96 |
$147.41 |
| A4623 |
Tracheostomy, inner cannula |
85 |
74 |
$137.26 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
14 |
13 |
$59.48 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
27 |
27 |
$0.00 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
46 |
43 |
$0.00 |