| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
33,469 |
3,621 |
$626K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,850 |
3,377 |
$622K |
| 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 |
961 |
841 |
$556K |
| 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 |
866 |
766 |
$366K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
6,220 |
2,841 |
$162K |
| 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 |
1,743 |
1,483 |
$148K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,040 |
1,729 |
$108K |
| E0776 |
Iv pole |
345 |
343 |
$50K |
| 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 |
554 |
427 |
$46K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
610 |
85 |
$40K |
| B9002 |
Enteral nutrition infusion pump, any type |
171 |
170 |
$21K |
| 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 |
59 |
53 |
$11K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
39 |
38 |
$6K |