| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,289 |
2,168 |
$123K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
769 |
532 |
$89K |
| 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 |
1,506 |
844 |
$45K |
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
630 |
246 |
$42K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,014 |
591 |
$24K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,665 |
1,051 |
$13K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
962 |
536 |
$10K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
32 |
24 |
$6K |
| 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 |
104 |
61 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
296 |
236 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
1,073 |
776 |
$5K |
| E0601 |
Continuous positive airway pressure (cpap) device |
330 |
231 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
356 |
200 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
550 |
337 |
$2K |
| K0001 |
Standard wheelchair |
522 |
338 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
271 |
151 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
518 |
389 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
528 |
290 |
$551.58 |
| A4623 |
Tracheostomy, inner cannula |
142 |
83 |
$537.65 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
146 |
115 |
$363.16 |
| A7002 |
Tubing, used with suction pump, each |
732 |
416 |
$222.07 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
16 |
13 |
$122.74 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
55 |
38 |
$94.34 |
| A7525 |
Tracheostomy mask, each |
248 |
141 |
$51.24 |
| E0776 |
Iv pole |
155 |
102 |
$50.44 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
85 |
52 |
$32.50 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
26 |
12 |
$15.54 |
| E0570 |
Nebulizer, with compressor |
42 |
39 |
$2.08 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
20 |
12 |
$0.00 |