| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,257 |
1,949 |
$1.70M |
| S8189 |
Tracheostomy supply, not otherwise classified |
16,459 |
4,218 |
$1.61M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,343 |
2,646 |
$1.47M |
| E0601 |
Continuous positive airway pressure (cpap) device |
17,882 |
14,929 |
$1.18M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14,422 |
12,211 |
$641K |
| B9998 |
Noc for enteral supplies |
4,232 |
1,906 |
$604K |
| 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 |
1,042 |
727 |
$466K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,730 |
1,511 |
$429K |
| A7030 |
Full face mask used with positive airway pressure device, each |
7,756 |
6,445 |
$384K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,904 |
3,019 |
$335K |
| E1399 |
Durable medical equipment, miscellaneous |
5,016 |
1,643 |
$328K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
3,247 |
2,429 |
$304K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
11,088 |
9,939 |
$277K |
| A4217 |
Sterile water/saline, 500 ml |
4,262 |
3,006 |
$276K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,182 |
1,694 |
$258K |
| 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) |
2,280 |
1,894 |
$220K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,403 |
2,751 |
$192K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,514 |
4,754 |
$188K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
3,089 |
2,434 |
$184K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
2,347 |
1,817 |
$180K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
7,116 |
6,046 |
$162K |
| 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 |
500 |
400 |
$159K |
| A4623 |
Tracheostomy, inner cannula |
1,687 |
1,092 |
$153K |
| A7035 |
Headgear used with positive airway pressure device |
11,008 |
9,540 |
$135K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,877 |
1,344 |
$134K |
| A7031 |
Face mask interface, replacement for full face mask, each |
6,380 |
4,934 |
$128K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,041 |
9,581 |
$115K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,884 |
1,955 |
$114K |
| E0570 |
Nebulizer, with compressor |
4,386 |
3,457 |
$85K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,049 |
784 |
$64K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,384 |
1,743 |
$61K |
| A4618 |
Breathing circuits |
2,504 |
1,835 |
$61K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,860 |
3,718 |
$60K |
| K0001 |
Standard wheelchair |
2,151 |
1,666 |
$42K |
| A7037 |
Tubing used with positive airway pressure device |
5,040 |
4,272 |
$39K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,136 |
4,358 |
$38K |
| B9002 |
Enteral nutrition infusion pump, any type |
392 |
348 |
$37K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,012 |
771 |
$37K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,337 |
1,931 |
$35K |
| A7002 |
Tubing, used with suction pump, each |
4,893 |
3,742 |
$33K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,433 |
1,181 |
$32K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,437 |
3,276 |
$29K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,563 |
2,677 |
$24K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,679 |
1,324 |
$24K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
947 |
665 |
$22K |
| L8501 |
Tracheostomy speaking valve |
372 |
321 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
3,673 |
2,692 |
$22K |
| K0003 |
Lightweight wheelchair |
627 |
493 |
$20K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,394 |
1,898 |
$20K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
93 |
70 |
$20K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,569 |
1,242 |
$19K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
11,563 |
9,599 |
$18K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,842 |
1,529 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,839 |
1,432 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
566 |
518 |
$12K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,394 |
1,212 |
$11K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,255 |
3,417 |
$10K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
67 |
65 |
$10K |
| A7525 |
Tracheostomy mask, each |
2,654 |
1,976 |
$10K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
696 |
222 |
$8K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,461 |
2,042 |
$8K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
156 |
107 |
$8K |
| 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 |
765 |
521 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
314 |
245 |
$7K |
| E0277 |
Powered pressure-reducing air mattress |
17 |
12 |
$5K |
| A4210 |
Needle-free injection device, each |
1,345 |
901 |
$5K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
177 |
172 |
$5K |
| A4244 |
Alcohol or peroxide, per pint |
2,011 |
1,543 |
$5K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
1,159 |
839 |
$5K |
| A7036 |
Chinstrap used with positive airway pressure device |
479 |
425 |
$3K |
| E0156 |
Seat attachment, walker |
272 |
235 |
$2K |
| A7012 |
Water collection device, used with large volume nebulizer |
993 |
717 |
$2K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
357 |
255 |
$2K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
29 |
26 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
919 |
792 |
$2K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
150 |
99 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
2,191 |
1,772 |
$1K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
40 |
25 |
$1K |
| E0776 |
Iv pole |
15 |
14 |
$810.22 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,180 |
1,883 |
$766.88 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
21 |
12 |
$470.94 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
21 |
12 |
$412.90 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
186 |
171 |
$403.17 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
26 |
25 |
$93.12 |