| 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 |
6,031 |
4,703 |
$3.76M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
16,838 |
12,820 |
$2.11M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
47,272 |
35,961 |
$1.61M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,820 |
2,277 |
$1.08M |
| 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 |
5,607 |
4,284 |
$1.01M |
| 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 |
1,616 |
1,371 |
$623K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
6,019 |
4,933 |
$616K |
| 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 |
6,929 |
5,107 |
$480K |
| E0601 |
Continuous positive airway pressure (cpap) device |
11,635 |
9,013 |
$349K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,104 |
823 |
$346K |
| A7030 |
Full face mask used with positive airway pressure device, each |
6,881 |
5,160 |
$346K |
| 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 |
1,546 |
1,144 |
$331K |
| A7031 |
Face mask interface, replacement for full face mask, each |
10,530 |
8,487 |
$298K |
| B9002 |
Enteral nutrition infusion pump, any type |
5,872 |
4,842 |
$293K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,688 |
3,515 |
$288K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
446 |
280 |
$264K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,450 |
5,880 |
$190K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,705 |
4,296 |
$174K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
5,607 |
4,529 |
$169K |
| 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 |
3,629 |
2,617 |
$164K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
19,454 |
14,895 |
$146K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
12,159 |
9,701 |
$137K |
| 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 |
747 |
555 |
$116K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,598 |
2,925 |
$99K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,271 |
5,452 |
$80K |
| A7035 |
Headgear used with positive airway pressure device |
7,447 |
5,642 |
$78K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
3,292 |
2,650 |
$78K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
21,112 |
16,809 |
$72K |
| E1392 |
Portable oxygen concentrator, rental |
7,456 |
5,689 |
$71K |
| E0570 |
Nebulizer, with compressor |
9,417 |
6,734 |
$71K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
4,023 |
3,329 |
$64K |
| 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) |
830 |
618 |
$57K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
729 |
512 |
$51K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
6,307 |
4,627 |
$39K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
3,293 |
2,591 |
$39K |
| B4100 |
Food thickener, administered orally, per ounce |
619 |
481 |
$36K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,372 |
1,643 |
$35K |
| A7526 |
Tracheostomy tube collar/holder, each |
882 |
660 |
$35K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
494 |
334 |
$34K |
| A7037 |
Tubing used with positive airway pressure device |
5,365 |
3,787 |
$32K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
757 |
530 |
$31K |
| E0776 |
Iv pole |
4,049 |
3,418 |
$31K |
| E0619 |
Apnea monitor, with recording feature |
250 |
212 |
$27K |
| 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 |
759 |
582 |
$25K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,423 |
1,078 |
$23K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
774 |
676 |
$22K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
546 |
426 |
$22K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
498 |
408 |
$15K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
201 |
145 |
$13K |
| E1130 |
Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests |
426 |
355 |
$13K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
393 |
329 |
$10K |
| B4082 |
Nasogastric tubing without stylet |
335 |
250 |
$8K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
507 |
335 |
$8K |
| B9998 |
Noc for enteral supplies |
431 |
358 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
630 |
493 |
$4K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
112 |
111 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
369 |
307 |
$3K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
970 |
494 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,131 |
2,337 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
241 |
203 |
$2K |
| A4618 |
Breathing circuits |
97 |
84 |
$2K |
| A4623 |
Tracheostomy, inner cannula |
16 |
12 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
258 |
197 |
$1K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
116 |
64 |
$791.05 |
| K0001 |
Standard wheelchair |
450 |
385 |
$773.15 |
| A7015 |
Aerosol mask, used with dme nebulizer |
754 |
564 |
$479.01 |
| A7525 |
Tracheostomy mask, each |
535 |
310 |
$400.67 |
| E0156 |
Seat attachment, walker |
32 |
25 |
$289.77 |
| A7036 |
Chinstrap used with positive airway pressure device |
35 |
31 |
$264.66 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
193 |
126 |
$221.92 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
426 |
339 |
$154.20 |