| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,248 |
2,196 |
$361K |
| 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 |
554 |
398 |
$50K |
| 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 |
742 |
521 |
$50K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
278 |
278 |
$40K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
296 |
286 |
$12K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
30 |
29 |
$10K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
98 |
85 |
$8K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
100 |
95 |
$2K |
| A4259 |
Lancets, per box of 100 |
117 |
117 |
$651.48 |
| E0607 |
Home blood glucose monitor |
12 |
12 |
$560.61 |