| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
24,293 |
22,737 |
$2.36M |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
25,950 |
17,152 |
$2.30M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
23,098 |
21,674 |
$2.13M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
17,957 |
16,623 |
$2.03M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
10,399 |
9,223 |
$1.93M |
| T4541 |
Incontinence product, disposable underpad, large, each |
47,771 |
44,845 |
$1.93M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
28,322 |
25,853 |
$1.82M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
14,648 |
5,739 |
$1.75M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12,674 |
11,492 |
$1.63M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,537 |
9,696 |
$1.56M |
| E1399 |
Durable medical equipment, miscellaneous |
2,689 |
1,901 |
$1.50M |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,208 |
2,039 |
$1.31M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,659 |
9,556 |
$1.27M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
14,737 |
13,233 |
$1.14M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,308 |
988 |
$1.12M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,978 |
5,535 |
$899K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
5,662 |
5,210 |
$895K |
| A4927 |
Gloves, non-sterile, per 100 |
32,028 |
29,933 |
$840K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,340 |
1,164 |
$734K |
| 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 |
5,289 |
4,538 |
$729K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,514 |
6,036 |
$718K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
17,060 |
14,143 |
$504K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,636 |
3,248 |
$481K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
2,773 |
2,520 |
$460K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
9,470 |
9,025 |
$456K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
3,151 |
2,838 |
$407K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
20,646 |
17,361 |
$401K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,787 |
1,630 |
$389K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,647 |
934 |
$352K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
7,505 |
4,009 |
$351K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,537 |
2,377 |
$341K |
| A4670 |
Automatic blood pressure monitor |
5,191 |
5,082 |
$335K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,587 |
1,535 |
$328K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
3,442 |
3,112 |
$280K |
| K0001 |
Standard wheelchair |
11,999 |
11,569 |
$273K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,008 |
1,662 |
$267K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
6,178 |
5,914 |
$248K |
| 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 |
1,412 |
1,174 |
$247K |
| E0277 |
Powered pressure-reducing air mattress |
1,343 |
1,206 |
$244K |
| K0003 |
Lightweight wheelchair |
6,183 |
5,912 |
$243K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
17,312 |
9,202 |
$234K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
5,285 |
4,911 |
$226K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,454 |
1,218 |
$201K |
| A4453 |
Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
547 |
373 |
$178K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
1,550 |
1,402 |
$178K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
3,016 |
2,742 |
$172K |
| A4452 |
Tape, waterproof, per 18 square inches |
8,359 |
7,534 |
$171K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
13,732 |
11,624 |
$165K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
4,641 |
4,305 |
$154K |
| A4217 |
Sterile water/saline, 500 ml |
5,075 |
4,528 |
$138K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
10,643 |
8,659 |
$134K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
2,548 |
2,483 |
$123K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,489 |
1,360 |
$121K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,907 |
1,555 |
$120K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
1,160 |
1,079 |
$114K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
319 |
252 |
$113K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
12,153 |
9,845 |
$102K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
17,374 |
9,118 |
$102K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
784 |
687 |
$101K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
2,375 |
1,838 |
$97K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12,241 |
11,484 |
$95K |
| A5120 |
Skin barrier, wipes or swabs, each |
9,342 |
8,766 |
$92K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
596 |
515 |
$86K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,146 |
1,034 |
$81K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,085 |
1,058 |
$80K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
720 |
674 |
$77K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
58 |
53 |
$76K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
342 |
278 |
$69K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,671 |
1,521 |
$68K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,306 |
1,275 |
$65K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
825 |
717 |
$64K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,332 |
1,202 |
$63K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,226 |
2,094 |
$60K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
1,273 |
1,249 |
$58K |
| E0266 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress |
493 |
430 |
$57K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
410 |
337 |
$56K |
| A4456 |
Adhesive remover, wipes, any type, each |
4,773 |
4,539 |
$54K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,284 |
1,874 |
$53K |
| E0570 |
Nebulizer, with compressor |
5,197 |
5,105 |
$53K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
456 |
405 |
$53K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
13 |
12 |
$52K |
| A4402 |
Lubricant, per ounce |
6,988 |
6,521 |
$50K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
408 |
389 |
$49K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
8,155 |
7,647 |
$48K |
| E0184 |
Dry pressure mattress |
3,134 |
3,069 |
$47K |
| E1012 |
Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each |
72 |
66 |
$46K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
780 |
758 |
$39K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,254 |
3,025 |
$39K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
388 |
342 |
$39K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,313 |
4,896 |
$39K |
| A7030 |
Full face mask used with positive airway pressure device, each |
427 |
419 |
$39K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
701 |
658 |
$38K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
823 |
652 |
$37K |
| K0040 |
Adjustable angle footplate, each |
1,388 |
805 |
$36K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
916 |
893 |
$33K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
637 |
623 |
$32K |
| K0007 |
Extra heavy duty wheelchair |
412 |
395 |
$31K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
186 |
140 |
$31K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
234 |
232 |
$31K |
| E0601 |
Continuous positive airway pressure (cpap) device |
710 |
704 |
$31K |
| A6451 |
Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
506 |
468 |
$30K |
| 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 |
218 |
187 |
$30K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
758 |
748 |
$30K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,661 |
1,590 |
$30K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
488 |
425 |
$29K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
330 |
305 |
$27K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
194 |
179 |
$26K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
442 |
411 |
$25K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
1,001 |
876 |
$24K |
| K0005 |
Ultralightweight wheelchair |
13 |
13 |
$23K |
| A4245 |
Alcohol wipes, per box |
4,625 |
4,365 |
$23K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
193 |
165 |
$22K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
601 |
578 |
$21K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
508 |
491 |
$21K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,867 |
1,721 |
$20K |
| E2203 |
Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 inches |
277 |
255 |
$19K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
179 |
123 |
$19K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
113 |
99 |
$19K |
| A7031 |
Face mask interface, replacement for full face mask, each |
522 |
512 |
$19K |
| B9002 |
Enteral nutrition infusion pump, any type |
268 |
210 |
$18K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
593 |
437 |
$17K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
62 |
62 |
$17K |
| A6260 |
Wound cleansers, any type, any size |
2,173 |
2,004 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,107 |
1,080 |
$17K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
63 |
60 |
$16K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
502 |
476 |
$15K |
| E2377 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue |
53 |
50 |
$15K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
689 |
507 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
478 |
475 |
$14K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
87 |
84 |
$13K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
348 |
302 |
$13K |
| E0156 |
Seat attachment, walker |
1,103 |
1,074 |
$13K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
575 |
500 |
$12K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
105 |
101 |
$12K |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
764 |
729 |
$12K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
177 |
174 |
$11K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
610 |
425 |
$11K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
337 |
325 |
$10K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
321 |
315 |
$10K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
187 |
107 |
$10K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
281 |
232 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
502 |
496 |
$10K |
| A4367 |
Ostomy belt, each |
1,284 |
1,199 |
$9K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
258 |
215 |
$9K |
| A4332 |
Lubricant, individual sterile packet, each |
670 |
601 |
$9K |
| A7526 |
Tracheostomy tube collar/holder, each |
203 |
185 |
$9K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,579 |
1,527 |
$8K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
442 |
427 |
$8K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
59 |
52 |
$8K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,519 |
1,312 |
$8K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
30 |
29 |
$7K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
795 |
429 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,601 |
2,416 |
$7K |
| 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 |
53 |
37 |
$7K |
| B9998 |
Noc for enteral supplies |
102 |
93 |
$7K |
| E0627 |
Seat lift mechanism, electric, any type |
25 |
25 |
$7K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
521 |
294 |
$7K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
106 |
93 |
$7K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
34 |
25 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,443 |
1,420 |
$6K |
| E0244 |
Raised toilet seat |
117 |
116 |
$6K |
| A4649 |
Surgical supply; miscellaneous |
385 |
326 |
$6K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
410 |
387 |
$5K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
13 |
12 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
283 |
279 |
$4K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,005 |
529 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
567 |
326 |
$4K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
28 |
27 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
292 |
251 |
$4K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
103 |
79 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
38 |
38 |
$3K |
| E2313 |
Power wheelchair accessory, harness for upgrade to expandable controller, including all fasteners, connectors and mounting hardware, each |
15 |
12 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
399 |
370 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
706 |
653 |
$3K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
13 |
12 |
$3K |
| K0019 |
Arm pad, replacement only, each |
206 |
148 |
$3K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
42 |
37 |
$3K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
279 |
231 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
171 |
171 |
$2K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
33 |
25 |
$2K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
27 |
24 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
464 |
431 |
$2K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
15 |
14 |
$2K |
| A4396 |
Ostomy belt with peristomal hernia support |
50 |
49 |
$2K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
12 |
12 |
$2K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
31 |
26 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
146 |
141 |
$2K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
68 |
54 |
$2K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
12 |
12 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
12 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
26 |
26 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
44 |
44 |
$926.07 |
| K0002 |
Standard hemi (low seat) wheelchair |
27 |
27 |
$898.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
393 |
381 |
$753.32 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
63 |
61 |
$623.08 |
| E0197 |
Air pressure pad for mattress, standard mattress length and width |
38 |
38 |
$512.28 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
30 |
27 |
$509.36 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
27 |
24 |
$422.85 |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
16 |
13 |
$408.67 |
| A4554 |
Disposable underpads, all sizes |
15 |
12 |
$326.80 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
16 |
14 |
$309.54 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
15 |
13 |
$304.83 |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
12 |
12 |
$281.52 |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
32 |
24 |
$76.69 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
69 |
68 |
$47.21 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
22 |
14 |
$0.00 |
| A9270 |
Non-covered item or service |
12 |
12 |
$0.00 |