| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,143 |
1,047 |
$1.18M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,498 |
2,011 |
$1.11M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
20,001 |
16,077 |
$969K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,759 |
5,752 |
$458K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,093 |
2,255 |
$290K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,010 |
3,371 |
$271K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,975 |
3,474 |
$208K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,636 |
1,872 |
$187K |
| A4217 |
Sterile water/saline, 500 ml |
2,809 |
1,533 |
$186K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,051 |
1,367 |
$186K |
| 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 |
1,760 |
683 |
$179K |
| B9998 |
Noc for enteral supplies |
2,884 |
1,426 |
$177K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
3,917 |
3,242 |
$159K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,054 |
842 |
$133K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,685 |
1,289 |
$116K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,604 |
2,966 |
$113K |
| 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) |
1,423 |
1,290 |
$110K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,173 |
3,538 |
$104K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,050 |
6,583 |
$103K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,505 |
724 |
$81K |
| A7035 |
Headgear used with positive airway pressure device |
5,957 |
4,949 |
$80K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,026 |
813 |
$77K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
806 |
627 |
$71K |
| S8189 |
Tracheostomy supply, not otherwise classified |
1,476 |
627 |
$64K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,440 |
1,631 |
$60K |
| 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 |
4,407 |
3,553 |
$56K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,302 |
898 |
$54K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,981 |
1,544 |
$52K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,077 |
1,376 |
$46K |
| A4605 |
Tracheal suction catheter, closed system, each |
135 |
118 |
$40K |
| 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 |
637 |
279 |
$39K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,087 |
1,600 |
$36K |
| E0570 |
Nebulizer, with compressor |
2,135 |
1,840 |
$36K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,439 |
944 |
$35K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
201 |
132 |
$33K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
901 |
831 |
$29K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,635 |
3,061 |
$28K |
| E1392 |
Portable oxygen concentrator, rental |
2,186 |
1,817 |
$27K |
| A7037 |
Tubing used with positive airway pressure device |
3,831 |
3,176 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,407 |
1,088 |
$22K |
| A4623 |
Tracheostomy, inner cannula |
144 |
114 |
$22K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,923 |
656 |
$21K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
147 |
138 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
14,450 |
7,940 |
$20K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,999 |
1,201 |
$20K |
| A7002 |
Tubing, used with suction pump, each |
2,020 |
1,568 |
$19K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
903 |
734 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,465 |
1,616 |
$19K |
| A4618 |
Breathing circuits |
860 |
501 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
1,471 |
1,003 |
$16K |
| K0001 |
Standard wheelchair |
1,081 |
912 |
$15K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
219 |
142 |
$14K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
504 |
393 |
$14K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
305 |
162 |
$13K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
329 |
273 |
$10K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
206 |
193 |
$8K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,815 |
586 |
$8K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
160 |
92 |
$6K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
120 |
111 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,924 |
1,482 |
$4K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
101 |
82 |
$4K |
| E0156 |
Seat attachment, walker |
311 |
285 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
313 |
258 |
$3K |
| A7525 |
Tracheostomy mask, each |
816 |
627 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
629 |
529 |
$2K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
72 |
67 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
1,236 |
962 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
179 |
151 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$1K |
| A4244 |
Alcohol or peroxide, per pint |
471 |
399 |
$839.50 |
| A6260 |
Wound cleansers, any type, any size |
35 |
33 |
$820.33 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
705 |
421 |
$755.77 |
| E0776 |
Iv pole |
66 |
50 |
$614.39 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
757 |
611 |
$605.25 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
133 |
113 |
$535.35 |
| K0003 |
Lightweight wheelchair |
13 |
12 |
$330.53 |
| E1399 |
Durable medical equipment, miscellaneous |
99 |
63 |
$194.94 |
| A7015 |
Aerosol mask, used with dme nebulizer |
93 |
83 |
$165.85 |