| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
128 |
123 |
$174K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
103 |
103 |
$28K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
215 |
185 |
$27K |
| A4605 |
Tracheal suction catheter, closed system, each |
56 |
56 |
$23K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
105 |
105 |
$19K |
| A7526 |
Tracheostomy tube collar/holder, each |
108 |
108 |
$16K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
171 |
150 |
$10K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
98 |
98 |
$5K |
| A7000 |
Canister, disposable, used with suction pump, each |
121 |
121 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
163 |
147 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
121 |
121 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
125 |
125 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
18 |
18 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
124 |
124 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
135 |
135 |
$2K |
| B9998 |
Noc for enteral supplies |
22 |
22 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
16 |
16 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
26 |
26 |
$1K |
| A7525 |
Tracheostomy mask, each |
18 |
18 |
$130.91 |