| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
44,757 |
44,712 |
$5.57M |
| E0601 |
Continuous positive airway pressure (cpap) device |
71,958 |
71,891 |
$3.66M |
| K0606 |
Automatic external defibrillator, with integrated electrocardiogram analysis, garment type |
1,728 |
1,727 |
$2.90M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,765 |
2,727 |
$2.15M |
| E1399 |
Durable medical equipment, miscellaneous |
743 |
683 |
$1.96M |
| E0570 |
Nebulizer, with compressor |
40,971 |
40,702 |
$1.63M |
| 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) |
11,056 |
11,045 |
$1.58M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
11,093 |
11,079 |
$1.49M |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
996 |
996 |
$1.18M |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
6,046 |
5,999 |
$924K |
| E2510 |
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access |
183 |
183 |
$857K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
1,466 |
1,055 |
$787K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
37,035 |
37,005 |
$779K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
68,963 |
68,929 |
$724K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
4,702 |
3,494 |
$624K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
1,386 |
1,380 |
$606K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,438 |
5,427 |
$593K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
519 |
493 |
$469K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,322 |
1,321 |
$456K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
6,758 |
6,744 |
$426K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
10,573 |
9,409 |
$358K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
850 |
801 |
$355K |
| L2280 |
Addition to lower extremity, molded inner boot |
984 |
671 |
$339K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
886 |
551 |
$338K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,579 |
4,575 |
$316K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,351 |
2,336 |
$309K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,895 |
1,810 |
$308K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
2,372 |
2,289 |
$297K |
| K0001 |
Standard wheelchair |
9,100 |
9,089 |
$256K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
3,286 |
3,160 |
$246K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,027 |
2,018 |
$235K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
5,874 |
5,148 |
$223K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
3,933 |
2,330 |
$220K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
568 |
541 |
$216K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
18,933 |
18,687 |
$209K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
3,502 |
3,406 |
$209K |
| A7035 |
Headgear used with positive airway pressure device |
8,366 |
8,352 |
$206K |
| K0003 |
Lightweight wheelchair |
4,656 |
4,651 |
$206K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,042 |
4,039 |
$205K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
2,323 |
2,322 |
$205K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
581 |
343 |
$198K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
471 |
332 |
$179K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,382 |
14,348 |
$168K |
| A7031 |
Face mask interface, replacement for full face mask, each |
4,184 |
4,178 |
$165K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
329 |
326 |
$146K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,133 |
1,090 |
$143K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
701 |
696 |
$142K |
| A4670 |
Automatic blood pressure monitor |
2,525 |
2,524 |
$140K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
6,417 |
6,414 |
$138K |
| A7037 |
Tubing used with positive airway pressure device |
8,070 |
8,060 |
$137K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
3,391 |
3,333 |
$135K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
832 |
832 |
$131K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
2,244 |
2,242 |
$123K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,623 |
1,576 |
$117K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
2,383 |
1,822 |
$114K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,676 |
997 |
$105K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
2,141 |
1,914 |
$103K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,257 |
1,220 |
$97K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,096 |
1,070 |
$90K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
1,395 |
875 |
$87K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
1,468 |
1,464 |
$83K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,018 |
994 |
$75K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,406 |
2,270 |
$71K |
| K0007 |
Extra heavy duty wheelchair |
1,176 |
1,175 |
$69K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
1,352 |
1,332 |
$66K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,430 |
1,404 |
$64K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
6,837 |
6,826 |
$62K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
4,071 |
3,769 |
$59K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,160 |
1,133 |
$58K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
2,683 |
2,683 |
$57K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,161 |
2,158 |
$57K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
894 |
892 |
$56K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,129 |
2,122 |
$54K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
352 |
352 |
$54K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,507 |
1,486 |
$52K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
282 |
263 |
$48K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,171 |
6,166 |
$44K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,195 |
2,132 |
$42K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
812 |
790 |
$42K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,292 |
2,081 |
$42K |
| E0277 |
Powered pressure-reducing air mattress |
123 |
123 |
$41K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
155 |
149 |
$40K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
794 |
777 |
$38K |
| A4623 |
Tracheostomy, inner cannula |
327 |
309 |
$37K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,843 |
1,823 |
$36K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
905 |
902 |
$36K |
| E0156 |
Seat attachment, walker |
2,475 |
2,471 |
$36K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
226 |
167 |
$36K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
248 |
236 |
$35K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
502 |
491 |
$31K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
517 |
506 |
$29K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
2,433 |
2,425 |
$29K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
540 |
539 |
$29K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
643 |
642 |
$28K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
220 |
204 |
$25K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
807 |
805 |
$23K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
169 |
156 |
$23K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,691 |
2,576 |
$22K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,007 |
1,978 |
$22K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,458 |
1,452 |
$22K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
171 |
166 |
$22K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
615 |
613 |
$21K |
| L3260 |
Surgical boot/shoe, each |
967 |
961 |
$21K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
240 |
240 |
$21K |
| A4335 |
Incontinence supply; miscellaneous |
290 |
290 |
$20K |
| L4397 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
192 |
169 |
$20K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
926 |
915 |
$20K |
| A7015 |
Aerosol mask, used with dme nebulizer |
18,638 |
18,388 |
$20K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
1,805 |
1,805 |
$18K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
362 |
361 |
$17K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
385 |
384 |
$17K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
449 |
449 |
$16K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,967 |
2,928 |
$16K |
| T4541 |
Incontinence product, disposable underpad, large, each |
284 |
283 |
$14K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
515 |
515 |
$14K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,022 |
5,005 |
$12K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
45 |
45 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
793 |
778 |
$10K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
320 |
224 |
$10K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
714 |
702 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
115 |
111 |
$10K |
| K0004 |
High strength, lightweight wheelchair |
177 |
177 |
$10K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,069 |
2,041 |
$9K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
858 |
846 |
$9K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
14 |
14 |
$8K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
31 |
27 |
$8K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
587 |
587 |
$8K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,489 |
1,464 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
1,344 |
1,325 |
$8K |
| A4367 |
Ostomy belt, each |
1,365 |
1,345 |
$7K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
28 |
28 |
$7K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
13 |
13 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,002 |
987 |
$6K |
| K0006 |
Heavy duty wheelchair |
115 |
114 |
$6K |
| E0635 |
Patient lift, electric with seat or sling |
49 |
49 |
$5K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
83 |
79 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
171 |
151 |
$3K |
| A7036 |
Chinstrap used with positive airway pressure device |
335 |
335 |
$3K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
25 |
25 |
$3K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
109 |
109 |
$3K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
51 |
51 |
$3K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
261 |
242 |
$2K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
37 |
36 |
$2K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
39 |
24 |
$2K |
| A4930 |
Gloves, sterile, per pair |
28 |
27 |
$2K |
| K0040 |
Adjustable angle footplate, each |
24 |
24 |
$2K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
38 |
37 |
$1K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
17 |
12 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$1K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
12 |
12 |
$1K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
127 |
116 |
$1K |
| A4402 |
Lubricant, per ounce |
723 |
718 |
$1K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
119 |
119 |
$1K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
15 |
13 |
$926.12 |
| A6260 |
Wound cleansers, any type, any size |
92 |
90 |
$806.54 |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
23 |
15 |
$799.50 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
89 |
88 |
$776.44 |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
15 |
15 |
$684.30 |
| A7525 |
Tracheostomy mask, each |
167 |
161 |
$664.74 |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$601.47 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
25 |
25 |
$510.60 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
12 |
12 |
$377.96 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
13 |
12 |
$353.69 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
26 |
25 |
$323.17 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
12 |
12 |
$182.52 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
14 |
14 |
$82.80 |
| A4259 |
Lancets, per box of 100 |
12 |
12 |
$10.77 |