| 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 |
10,042 |
9,312 |
$354K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,651 |
4,318 |
$314K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,311 |
6,949 |
$293K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
6,970 |
6,480 |
$181K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,900 |
3,601 |
$176K |
| A7031 |
Face mask interface, replacement for full face mask, each |
5,307 |
4,849 |
$170K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,387 |
4,164 |
$115K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,214 |
2,097 |
$82K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,129 |
1,925 |
$70K |
| A7035 |
Headgear used with positive airway pressure device |
5,034 |
4,687 |
$64K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
233 |
224 |
$62K |
| E0570 |
Nebulizer, with compressor |
4,936 |
4,783 |
$61K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,951 |
1,763 |
$49K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
196 |
188 |
$47K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,916 |
5,424 |
$41K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
8,875 |
8,208 |
$39K |
| S9999 |
Sales tax |
3,097 |
2,912 |
$38K |
| 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) |
470 |
445 |
$35K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
163 |
160 |
$34K |
| K0001 |
Standard wheelchair |
2,239 |
2,127 |
$34K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,614 |
3,353 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
262 |
244 |
$23K |
| T4541 |
Incontinence product, disposable underpad, large, each |
408 |
385 |
$19K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
67 |
63 |
$17K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
79 |
78 |
$14K |
| A7037 |
Tubing used with positive airway pressure device |
940 |
880 |
$14K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
379 |
363 |
$10K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
337 |
329 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
335 |
293 |
$7K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
144 |
136 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
739 |
690 |
$6K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
25 |
25 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,398 |
1,300 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
26 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
62 |
54 |
$4K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
13 |
12 |
$3K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
41 |
28 |
$3K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
152 |
119 |
$3K |
| E0156 |
Seat attachment, walker |
338 |
321 |
$2K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
12 |
12 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
42 |
41 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
81 |
72 |
$1K |
| E0203 |
Therapeutic lightbox, minimum 10,000 lux, table top model |
15 |
12 |
$981.97 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
47 |
27 |
$815.04 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
68 |
64 |
$797.06 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$603.93 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
57 |
51 |
$594.89 |
| E0245 |
Tub stool or bench |
12 |
12 |
$552.30 |
| A7036 |
Chinstrap used with positive airway pressure device |
34 |
30 |
$215.92 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
106 |
101 |
$203.58 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
13 |
12 |
$144.75 |
| A5120 |
Skin barrier, wipes or swabs, each |
20 |
19 |
$76.65 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
13 |
13 |
$61.59 |