| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,291 |
946 |
$873K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,378 |
9,910 |
$866K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,766 |
1,935 |
$439K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,245 |
2,019 |
$364K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
825 |
521 |
$310K |
| A4623 |
Tracheostomy, inner cannula |
1,710 |
1,056 |
$137K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,428 |
984 |
$131K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,022 |
1,396 |
$122K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,512 |
2,016 |
$122K |
| 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 |
1,689 |
904 |
$113K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,049 |
848 |
$78K |
| 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) |
729 |
558 |
$76K |
| A7030 |
Full face mask used with positive airway pressure device, each |
829 |
747 |
$70K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,331 |
1,644 |
$68K |
| E1392 |
Portable oxygen concentrator, rental |
3,260 |
2,778 |
$65K |
| 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 |
311 |
171 |
$62K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,826 |
881 |
$61K |
| L8501 |
Tracheostomy speaking valve |
1,131 |
766 |
$58K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,905 |
2,643 |
$51K |
| 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 |
770 |
434 |
$48K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,007 |
902 |
$48K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,361 |
1,654 |
$38K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,269 |
1,964 |
$38K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,095 |
703 |
$35K |
| A4554 |
Disposable underpads, all sizes |
664 |
616 |
$33K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
187 |
171 |
$29K |
| K0001 |
Standard wheelchair |
1,767 |
1,532 |
$28K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,006 |
723 |
$27K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,014 |
1,600 |
$26K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
620 |
544 |
$24K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
885 |
747 |
$21K |
| E0570 |
Nebulizer, with compressor |
723 |
707 |
$18K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
605 |
447 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
1,038 |
906 |
$17K |
| A7031 |
Face mask interface, replacement for full face mask, each |
678 |
542 |
$17K |
| A7037 |
Tubing used with positive airway pressure device |
606 |
549 |
$16K |
| B9998 |
Noc for enteral supplies |
1,801 |
791 |
$15K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,184 |
1,114 |
$13K |
| K0003 |
Lightweight wheelchair |
280 |
242 |
$11K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
488 |
433 |
$8K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
263 |
230 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
127 |
117 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
1,992 |
1,460 |
$6K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,241 |
981 |
$5K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
288 |
283 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,333 |
1,070 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
541 |
447 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
45 |
38 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
53 |
38 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
981 |
632 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,262 |
1,033 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
14 |
13 |
$1K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
112 |
83 |
$1K |
| E0156 |
Seat attachment, walker |
105 |
86 |
$760.64 |
| A7525 |
Tracheostomy mask, each |
1,776 |
970 |
$745.99 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$587.00 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
51 |
41 |
$91.68 |
| E0184 |
Dry pressure mattress |
20 |
12 |
$57.38 |
| A7015 |
Aerosol mask, used with dme nebulizer |
28 |
24 |
$38.23 |