| 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 |
13,780 |
7,763 |
$523K |
| E0601 |
Continuous positive airway pressure (cpap) device |
15,947 |
10,052 |
$488K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,286 |
1,920 |
$327K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,972 |
3,225 |
$326K |
| E0570 |
Nebulizer, with compressor |
9,819 |
6,172 |
$310K |
| A4554 |
Disposable underpads, all sizes |
3,182 |
2,496 |
$156K |
| 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) |
2,561 |
1,505 |
$139K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,022 |
832 |
$137K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
966 |
590 |
$88K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,333 |
2,939 |
$83K |
| A7037 |
Tubing used with positive airway pressure device |
5,483 |
4,435 |
$82K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,824 |
6,624 |
$69K |
| A7035 |
Headgear used with positive airway pressure device |
4,194 |
3,418 |
$68K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,627 |
2,111 |
$64K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,732 |
1,349 |
$63K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,967 |
2,452 |
$58K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,298 |
1,100 |
$57K |
| K0001 |
Standard wheelchair |
7,389 |
4,040 |
$45K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,361 |
1,081 |
$44K |
| A4670 |
Automatic blood pressure monitor |
833 |
525 |
$32K |
| 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 |
709 |
365 |
$30K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
260 |
201 |
$30K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,578 |
5,331 |
$21K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
91 |
64 |
$13K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
452 |
328 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,904 |
1,515 |
$8K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,057 |
2,564 |
$5K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
668 |
655 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
245 |
135 |
$3K |
| E0156 |
Seat attachment, walker |
348 |
273 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
90 |
72 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
521 |
351 |
$1K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
63 |
58 |
$1K |
| 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 |
88 |
61 |
$1K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
135 |
83 |
$969.46 |
| 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 |
74 |
49 |
$760.48 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
287 |
283 |
$580.20 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
17 |
12 |
$481.28 |
| A4259 |
Lancets, per box of 100 |
200 |
150 |
$123.30 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
55 |
50 |
$113.95 |