| 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 |
5,330 |
5,089 |
$455K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,891 |
4,676 |
$409K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
564 |
351 |
$319K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,703 |
2,582 |
$173K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,773 |
1,676 |
$156K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
937 |
914 |
$149K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,915 |
3,741 |
$141K |
| 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) |
221 |
218 |
$99K |
| E0570 |
Nebulizer, with compressor |
2,199 |
2,071 |
$94K |
| A7035 |
Headgear used with positive airway pressure device |
3,905 |
3,751 |
$89K |
| 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) |
530 |
503 |
$79K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,442 |
3,273 |
$51K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,877 |
6,566 |
$46K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,401 |
1,291 |
$44K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
177 |
165 |
$39K |
| A4927 |
Gloves, non-sterile, per 100 |
2,815 |
2,459 |
$29K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,120 |
1,039 |
$28K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,334 |
2,241 |
$28K |
| A4217 |
Sterile water/saline, 500 ml |
353 |
293 |
$28K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
640 |
554 |
$25K |
| A4605 |
Tracheal suction catheter, closed system, each |
108 |
102 |
$24K |
| K0001 |
Standard wheelchair |
470 |
450 |
$20K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,280 |
2,161 |
$19K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
211 |
192 |
$19K |
| A7526 |
Tracheostomy tube collar/holder, each |
358 |
297 |
$17K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
247 |
243 |
$15K |
| A7000 |
Canister, disposable, used with suction pump, each |
464 |
412 |
$15K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
463 |
459 |
$14K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
298 |
263 |
$14K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
210 |
200 |
$14K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
469 |
454 |
$12K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
460 |
452 |
$12K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
79 |
79 |
$11K |
| E1372 |
Immersion external heater for nebulizer |
110 |
98 |
$11K |
| T4541 |
Incontinence product, disposable underpad, large, each |
390 |
377 |
$11K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
163 |
158 |
$10K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
165 |
165 |
$9K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
103 |
92 |
$8K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
62 |
48 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
503 |
467 |
$8K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
95 |
95 |
$7K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
296 |
279 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
91 |
87 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
65 |
64 |
$5K |
| E0294 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
39 |
38 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
59 |
58 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
190 |
179 |
$5K |
| A4623 |
Tracheostomy, inner cannula |
27 |
26 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
55 |
54 |
$4K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
155 |
138 |
$4K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
69 |
68 |
$3K |
| 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 |
75 |
75 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
48 |
46 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
300 |
261 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
249 |
216 |
$2K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
30 |
27 |
$2K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
31 |
29 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
95 |
94 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
444 |
436 |
$981.86 |
| E1392 |
Portable oxygen concentrator, rental |
26 |
26 |
$971.10 |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
13 |
$669.13 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
24 |
24 |
$533.17 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
13 |
13 |
$520.78 |
| E0156 |
Seat attachment, walker |
28 |
27 |
$515.80 |
| A7015 |
Aerosol mask, used with dme nebulizer |
207 |
205 |
$307.92 |
| A7012 |
Water collection device, used with large volume nebulizer |
29 |
26 |
$240.08 |
| A4618 |
Breathing circuits |
15 |
13 |
$214.38 |
| A7525 |
Tracheostomy mask, each |
42 |
40 |
$194.51 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
44 |
40 |
$163.36 |