| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,230 |
1,758 |
$1.06M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
38,418 |
33,274 |
$971K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,665 |
4,857 |
$772K |
| 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 |
2,635 |
2,211 |
$414K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,790 |
1,477 |
$182K |
| 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 |
3,276 |
2,392 |
$154K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,278 |
2,156 |
$121K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,065 |
2,710 |
$110K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,849 |
15,561 |
$106K |
| E0570 |
Nebulizer, with compressor |
10,287 |
9,316 |
$37K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
137 |
108 |
$35K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,165 |
945 |
$28K |
| E0776 |
Iv pole |
3,231 |
2,733 |
$21K |
| E1392 |
Portable oxygen concentrator, rental |
2,473 |
2,246 |
$20K |
| A7031 |
Face mask interface, replacement for full face mask, each |
911 |
853 |
$17K |
| K0001 |
Standard wheelchair |
1,758 |
1,504 |
$13K |
| A7030 |
Full face mask used with positive airway pressure device, each |
322 |
307 |
$11K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
988 |
886 |
$10K |
| B4100 |
Food thickener, administered orally, per ounce |
138 |
88 |
$10K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,822 |
1,642 |
$7K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
325 |
302 |
$6K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
714 |
639 |
$6K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
16 |
12 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,549 |
2,349 |
$5K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
58 |
41 |
$4K |
| B9998 |
Noc for enteral supplies |
556 |
344 |
$4K |
| E0601 |
Continuous positive airway pressure (cpap) device |
314 |
276 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
259 |
236 |
$3K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
38 |
26 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
494 |
446 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
689 |
646 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
628 |
528 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,819 |
4,159 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
310 |
287 |
$1K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
18 |
12 |
$1K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
39 |
37 |
$666.66 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
218 |
210 |
$534.03 |
| A7015 |
Aerosol mask, used with dme nebulizer |
879 |
783 |
$411.03 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
74 |
49 |
$374.88 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
785 |
712 |
$210.23 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
161 |
149 |
$208.67 |