| 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 |
9,731 |
8,101 |
$321K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
404 |
299 |
$94K |
| 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 |
1,008 |
524 |
$39K |
| 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 |
1,040 |
537 |
$34K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,625 |
3,817 |
$34K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,450 |
1,121 |
$33K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,164 |
1,537 |
$15K |
| E0570 |
Nebulizer, with compressor |
978 |
731 |
$11K |
| A7030 |
Full face mask used with positive airway pressure device, each |
240 |
182 |
$10K |
| A7037 |
Tubing used with positive airway pressure device |
344 |
271 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
71 |
55 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
125 |
98 |
$993.59 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
387 |
298 |
$750.99 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
12 |
12 |
$558.12 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
62 |
55 |
$229.21 |
| K0001 |
Standard wheelchair |
53 |
38 |
$146.89 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
15 |
13 |
$17.66 |