| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4189 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix |
10,047 |
1,728 |
$6.81M |
| B4185 |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
7,901 |
1,826 |
$1.90M |
| B4224 |
Parenteral nutrition administration kit, per day |
18,563 |
2,427 |
$1.28M |
| 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 |
1,284 |
868 |
$692K |
| J1726 |
Injection, hydroxyprogesterone caproate, (makena), 10 mg |
814 |
256 |
$671K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
1,260 |
477 |
$448K |
| B4105 |
In-line cartridge containing digestive enzyme(s) for enteral feeding, each |
67 |
64 |
$425K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
18,460 |
2,423 |
$412K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
18,753 |
2,072 |
$380K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
5,097 |
1,425 |
$292K |
| 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 |
503 |
369 |
$112K |
| 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 |
977 |
602 |
$105K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,817 |
1,084 |
$79K |
| G0299 |
Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutes |
584 |
226 |
$51K |
| 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 |
259 |
206 |
$30K |
| B9004 |
Parenteral nutrition infusion pump, portable |
120 |
116 |
$30K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,904 |
1,528 |
$26K |
| A4245 |
Alcohol wipes, per box |
3,715 |
1,855 |
$12K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
1,536 |
793 |
$10K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,945 |
812 |
$9K |
| B9998 |
Noc for enteral supplies |
951 |
666 |
$8K |
| J3490 |
Unclassified drugs |
298 |
51 |
$7K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
694 |
285 |
$4K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
901 |
130 |
$3K |
| 99601 |
|
130 |
53 |
$3K |
| E0776 |
Iv pole |
89 |
89 |
$3K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
41 |
36 |
$3K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
256 |
134 |
$2K |
| J7030 |
Infusion, normal saline solution , 1000 cc |
370 |
180 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
53 |
51 |
$2K |
| A4215 |
Needle, sterile, any size, each |
168 |
73 |
$2K |
| J1644 |
Injection, heparin sodium, per 1000 units |
744 |
182 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
453 |
222 |
$1K |
| S1015 |
Iv tubing extension set |
65 |
39 |
$850.33 |
| A4452 |
Tape, waterproof, per 18 square inches |
171 |
143 |
$692.56 |
| A4211 |
Supplies for self-administered injections |
217 |
12 |
$342.54 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
17 |
15 |
$301.62 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
22 |
14 |
$117.36 |
| J7050 |
Infusion, normal saline solution, 250 cc |
35 |
14 |
$101.17 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
30 |
12 |
$10.73 |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
45 |
30 |
$0.00 |