| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
260,201 |
137,546 |
$20.92M |
| A4554 |
Disposable underpads, all sizes |
546,627 |
540,936 |
$16.72M |
| A4575 |
Topical hyperbaric oxygen chamber, disposable |
2,557 |
2,476 |
$15.08M |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
175,192 |
90,798 |
$14.91M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
19,825 |
19,596 |
$14.54M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
243,820 |
241,021 |
$13.35M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
41,835 |
41,677 |
$11.16M |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
177,461 |
93,927 |
$10.72M |
| L3001 |
Foot, insert, removable, molded to patient model, spenco, each |
116,163 |
58,420 |
$10.30M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
462,509 |
455,018 |
$10.28M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
61,980 |
60,579 |
$9.53M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
120,763 |
119,079 |
$9.14M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
207,428 |
205,254 |
$8.51M |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
38,206 |
23,258 |
$8.29M |
| E1399 |
Durable medical equipment, miscellaneous |
25,161 |
22,984 |
$8.18M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
9,656 |
9,139 |
$8.15M |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
116,699 |
61,627 |
$7.65M |
| 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 |
10,995 |
10,682 |
$6.87M |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
29,302 |
16,213 |
$6.67M |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
24,268 |
23,729 |
$6.59M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
93,214 |
91,045 |
$6.35M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
13,875 |
13,825 |
$6.28M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
35,774 |
35,219 |
$5.51M |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
76,088 |
39,815 |
$5.33M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
200,312 |
198,458 |
$4.68M |
| E0601 |
Continuous positive airway pressure (cpap) device |
119,830 |
118,662 |
$4.63M |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
9,364 |
9,354 |
$4.49M |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
11,924 |
7,933 |
$4.30M |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
78,770 |
77,840 |
$4.05M |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
32,792 |
20,169 |
$3.99M |
| L3410 |
Metatarsal bar wedge, between sole |
70,761 |
36,269 |
$3.82M |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
88,383 |
47,740 |
$3.67M |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
142,904 |
141,740 |
$3.24M |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
82,393 |
43,005 |
$3.24M |
| L3217 |
Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
41,709 |
22,239 |
$3.19M |
| L3480 |
Heel, pad and depression for spur |
159,139 |
81,646 |
$3.12M |
| 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 |
33,794 |
33,126 |
$2.78M |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
53,888 |
28,917 |
$2.77M |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
4,664 |
4,648 |
$2.57M |
| 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 |
23,072 |
22,734 |
$2.55M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
11,588 |
11,207 |
$2.54M |
| E0575 |
Nebulizer, ultrasonic, large volume |
10,959 |
10,938 |
$2.52M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
14,400 |
14,262 |
$2.49M |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
6,141 |
5,902 |
$2.45M |
| E0570 |
Nebulizer, with compressor |
51,620 |
51,076 |
$2.38M |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
11,109 |
11,094 |
$2.24M |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
15,543 |
9,123 |
$2.09M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
14,672 |
14,458 |
$2.07M |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
17,093 |
9,629 |
$2.05M |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
9,260 |
9,228 |
$1.87M |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
18,816 |
10,207 |
$1.82M |
| L3222 |
Orthopedic footwear, mens shoe, hightop, depth inlay, each |
20,189 |
10,853 |
$1.81M |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
3,961 |
2,707 |
$1.79M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
36,802 |
36,606 |
$1.77M |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
11,433 |
8,982 |
$1.73M |
| A7030 |
Full face mask used with positive airway pressure device, each |
20,090 |
19,748 |
$1.66M |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
22,264 |
12,686 |
$1.65M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
11,011 |
10,270 |
$1.64M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
32,532 |
32,141 |
$1.59M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
35,051 |
33,623 |
$1.56M |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
43,901 |
42,544 |
$1.54M |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
866 |
832 |
$1.51M |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
8,040 |
7,983 |
$1.49M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
38,557 |
36,832 |
$1.48M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
16,605 |
16,079 |
$1.36M |
| L2114 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment |
4,774 |
4,723 |
$1.34M |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
75,816 |
75,313 |
$1.32M |
| A4927 |
Gloves, non-sterile, per 100 |
276,862 |
268,771 |
$1.31M |
| 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 |
5,753 |
5,577 |
$1.26M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
5,597 |
5,360 |
$1.24M |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
27,569 |
15,748 |
$1.21M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
7,141 |
7,026 |
$1.21M |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
31,610 |
31,304 |
$1.17M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
13,308 |
12,236 |
$1.14M |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
4,911 |
4,900 |
$1.12M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
17,567 |
17,303 |
$1.10M |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
30,828 |
17,427 |
$1.09M |
| A6540 |
Gradient compression stocking, waist length, 30-40 mmhg, each |
5,084 |
4,164 |
$1.09M |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
1,773 |
1,155 |
$1.05M |
| A6023 |
Collagen dressing, sterile, size more than 48 sq. in., each |
1,800 |
1,777 |
$1.04M |
| A4335 |
Incontinence supply; miscellaneous |
38,270 |
36,301 |
$1000K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
13,064 |
9,196 |
$990K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
12,702 |
12,554 |
$946K |
| K0001 |
Standard wheelchair |
56,000 |
55,518 |
$936K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
26,903 |
13,724 |
$933K |
| L3485 |
Heel, pad, removable for spur |
31,922 |
16,354 |
$904K |
| L2112 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment |
3,307 |
3,291 |
$897K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
55,950 |
54,869 |
$888K |
| A6247 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
2,648 |
2,618 |
$884K |
| L3430 |
Heel, counter, plastic reinforced |
8,822 |
4,562 |
$871K |
| B9998 |
Noc for enteral supplies |
2,432 |
2,253 |
$825K |
| 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 |
10,358 |
10,116 |
$818K |
| L3230 |
Orthopedic footwear, custom shoe, depth inlay, each |
3,769 |
1,880 |
$794K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
81,323 |
80,593 |
$794K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
31,643 |
31,396 |
$788K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
14,645 |
7,783 |
$772K |
| A4670 |
Automatic blood pressure monitor |
25,006 |
24,829 |
$767K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
20,720 |
20,393 |
$766K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
15,038 |
14,200 |
$759K |
| 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) |
6,856 |
6,770 |
$734K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
1,220 |
814 |
$719K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
764 |
760 |
$710K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
11,011 |
10,866 |
$710K |
| L3390 |
Outflare wedge |
25,899 |
13,203 |
$708K |
| E1815 |
Dynamic adjustable ankle extension and flexion device, includes soft interface material |
2,015 |
1,502 |
$699K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
3,607 |
3,569 |
$694K |
| A6244 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,528 |
2,509 |
$655K |
| T4541 |
Incontinence product, disposable underpad, large, each |
24,929 |
23,041 |
$654K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
17,239 |
9,885 |
$644K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
2,484 |
1,639 |
$624K |
| L0631 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,130 |
1,127 |
$616K |
| A7031 |
Face mask interface, replacement for full face mask, each |
14,294 |
14,143 |
$610K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
3,073 |
992 |
$554K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
2,364 |
2,359 |
$548K |
| L2280 |
Addition to lower extremity, molded inner boot |
1,450 |
905 |
$487K |
| L3360 |
Sole wedge, outside sole |
22,349 |
11,171 |
$477K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
11,086 |
11,001 |
$471K |
| E0241 |
Bath tub wall rail, each |
20,843 |
20,665 |
$467K |
| A7035 |
Headgear used with positive airway pressure device |
34,078 |
33,703 |
$451K |
| L3710 |
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
7,993 |
4,297 |
$447K |
| 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 |
2,689 |
2,640 |
$438K |
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
917 |
917 |
$433K |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
14,063 |
7,027 |
$433K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
24,773 |
18,812 |
$428K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
4,709 |
4,619 |
$422K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
3,821 |
3,792 |
$418K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
6,243 |
5,953 |
$417K |
| A6236 |
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,935 |
1,917 |
$412K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,760 |
1,713 |
$409K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
981 |
557 |
$405K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,140 |
3,098 |
$405K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
3,296 |
2,110 |
$404K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
742 |
660 |
$400K |
| L3050 |
Foot, arch support, removable, premolded, metatarsal, each |
12,810 |
6,665 |
$385K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
9,701 |
9,561 |
$375K |
| L3450 |
Heel, sach cushion type |
4,739 |
2,794 |
$368K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
9,713 |
8,319 |
$367K |
| L3203 |
Orthopedic shoe, oxford with supinator or pronator, junior |
8,905 |
4,616 |
$366K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
6,651 |
3,757 |
$365K |
| L1930 |
Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment |
2,347 |
1,426 |
$360K |
| E0277 |
Powered pressure-reducing air mattress |
1,944 |
1,910 |
$350K |
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
749 |
743 |
$348K |
| L3003 |
Foot, insert, removable, molded to patient model, silicone gel, each |
3,957 |
1,984 |
$347K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
7,518 |
3,796 |
$347K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
10,010 |
9,937 |
$341K |
| A7037 |
Tubing used with positive airway pressure device |
32,683 |
32,531 |
$335K |
| K0003 |
Lightweight wheelchair |
8,484 |
8,408 |
$335K |
| A4605 |
Tracheal suction catheter, closed system, each |
2,368 |
2,306 |
$335K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
6,673 |
6,538 |
$334K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
5,845 |
3,032 |
$330K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
6,023 |
3,287 |
$322K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,307 |
4,194 |
$312K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,142 |
1,936 |
$309K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
18,592 |
18,304 |
$308K |
| E1392 |
Portable oxygen concentrator, rental |
9,853 |
9,764 |
$281K |
| E0748 |
Osteogenesis stimulator, electrical, non-invasive, spinal applications |
119 |
118 |
$273K |
| A4402 |
Lubricant, per ounce |
31,239 |
30,313 |
$272K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
19,657 |
19,461 |
$257K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
4,732 |
4,531 |
$244K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
6,451 |
6,404 |
$233K |
| L3207 |
Orthopedic shoe, hightop with supinator or pronator, junior |
7,006 |
3,502 |
$232K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,459 |
5,115 |
$229K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
1,894 |
1,831 |
$225K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
3,929 |
2,770 |
$220K |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,299 |
2,255 |
$212K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
3,177 |
3,079 |
$210K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
4,189 |
2,847 |
$209K |
| E0667 |
Segmental pneumatic appliance for use with pneumatic compressor, full leg |
984 |
545 |
$205K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
6,143 |
6,097 |
$197K |
| E0243 |
Toilet rail, each |
6,214 |
6,166 |
$192K |
| E0156 |
Seat attachment, walker |
22,584 |
22,356 |
$191K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
765 |
724 |
$190K |
| A4400 |
Ostomy irrigation set |
690 |
681 |
$186K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
5,335 |
5,124 |
$183K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
3,225 |
3,196 |
$179K |
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
6,354 |
6,298 |
$176K |
| E0651 |
Pneumatic compressor, segmental home model without calibrated gradient pressure |
319 |
319 |
$171K |
| L3340 |
Heel wedge, sach |
5,274 |
2,651 |
$171K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,451 |
3,293 |
$170K |
| L3915 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
618 |
355 |
$167K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
3,443 |
2,643 |
$166K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
500 |
448 |
$165K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
195 |
184 |
$164K |
| E0784 |
External ambulatory infusion pump, insulin |
42 |
42 |
$164K |
| L5301 |
Below knee, molded socket, shin, sach foot, endoskeletal system |
133 |
118 |
$164K |
| A7000 |
Canister, disposable, used with suction pump, each |
9,822 |
9,397 |
$162K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
3,514 |
3,357 |
$161K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,044 |
1,961 |
$159K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
6,006 |
4,475 |
$156K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
6,807 |
6,332 |
$154K |
| L3060 |
Foot, arch support, removable, premolded, longitudinal/ metatarsal, each |
4,510 |
2,477 |
$154K |
| A6198 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing |
1,552 |
1,536 |
$151K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
422 |
371 |
$148K |
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
583 |
359 |
$145K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
39,159 |
38,609 |
$143K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,113 |
1,103 |
$143K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
1,739 |
1,714 |
$143K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
2,125 |
2,093 |
$142K |
| L3760 |
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
852 |
436 |
$141K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
409 |
368 |
$141K |
| L5620 |
Addition to lower extremity, test socket, below knee |
640 |
564 |
$141K |
| L5637 |
Addition to lower extremity, below knee, total contact |
597 |
531 |
$141K |
| L0649 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
974 |
833 |
$138K |
| L3400 |
Metatarsal bar wedge, rocker |
5,480 |
2,741 |
$133K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,684 |
1,656 |
$129K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14,789 |
14,362 |
$128K |
| A4259 |
Lancets, per box of 100 |
76,403 |
75,807 |
$127K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
936 |
926 |
$124K |
| A5120 |
Skin barrier, wipes or swabs, each |
19,549 |
18,410 |
$124K |
| E0244 |
Raised toilet seat |
9,977 |
9,859 |
$123K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
3,538 |
3,393 |
$123K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
540 |
526 |
$118K |
| L5679 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism |
224 |
191 |
$117K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
5,025 |
4,980 |
$116K |
| L3702 |
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
622 |
341 |
$114K |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
442 |
441 |
$113K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
2,968 |
2,874 |
$113K |
| E0580 |
Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter |
1,421 |
1,412 |
$112K |
| K0006 |
Heavy duty wheelchair |
1,881 |
1,873 |
$110K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
490 |
434 |
$110K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,323 |
1,213 |
$109K |
| A5122 |
Skin barrier; solid, 8 x 8 or equivalent, each |
912 |
909 |
$103K |
| 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 |
1,818 |
1,765 |
$102K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,317 |
1,214 |
$101K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,719 |
1,639 |
$101K |
| A4378 |
Ostomy pouch, drainable, for use on faceplate, rubber, each |
414 |
404 |
$100K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
433 |
383 |
$98K |
| E0607 |
Home blood glucose monitor |
3,115 |
3,089 |
$98K |
| A4217 |
Sterile water/saline, 500 ml |
7,747 |
7,589 |
$96K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
4,714 |
4,526 |
$93K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
6,106 |
6,017 |
$91K |
| S5160 |
Emergency response system; installation and testing |
1,469 |
1,424 |
$86K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,142 |
610 |
$86K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,806 |
2,709 |
$86K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
6,719 |
6,568 |
$86K |
| 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 |
5,763 |
5,680 |
$84K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
3,042 |
2,793 |
$83K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
382 |
274 |
$83K |
| L3995 |
Addition to upper extremity orthosis, sock, fracture or equal, each |
1,729 |
1,551 |
$82K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,013 |
939 |
$80K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
7,637 |
4,904 |
$79K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
26,276 |
25,966 |
$78K |
| L2116 |
Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment |
214 |
214 |
$73K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,327 |
1,257 |
$71K |
| K0848 |
Power wheelchair, group 3 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
179 |
178 |
$71K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,096 |
613 |
$70K |
| L1910 |
Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment |
531 |
288 |
$70K |
| K0824 |
Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight capacity 301 to 450 pounds |
544 |
542 |
$70K |
| E0147 |
Walker, heavy duty, multiple braking system, variable wheel resistance |
602 |
580 |
$70K |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
3,711 |
3,700 |
$69K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
2,339 |
1,389 |
$69K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,764 |
1,655 |
$68K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
1,279 |
1,238 |
$68K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,321 |
1,313 |
$67K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
6,132 |
5,957 |
$65K |
| L3320 |
Lift, elevation, heel and sole, cork, per inch |
1,407 |
772 |
$65K |
| L2250 |
Addition to lower extremity, foot plate, molded to patient model, stirrup attachment |
274 |
172 |
$64K |
| L1851 |
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
249 |
202 |
$63K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
518 |
494 |
$63K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,807 |
2,679 |
$62K |
| A7002 |
Tubing, used with suction pump, each |
9,417 |
9,270 |
$62K |
| E0855 |
Cervical traction equipment not requiring additional stand or frame |
160 |
160 |
$62K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,537 |
2,445 |
$60K |
| A4245 |
Alcohol wipes, per box |
70,419 |
69,984 |
$59K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
520 |
509 |
$58K |
| L3332 |
Lift, elevation, inside shoe, tapered, up to one-half inch |
1,190 |
819 |
$58K |
| L5704 |
Custom shaped protective cover, below knee |
151 |
134 |
$56K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
536 |
511 |
$55K |
| L3031 |
Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each |
807 |
402 |
$53K |
| L3224 |
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
1,247 |
629 |
$53K |
| L1843 |
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
98 |
95 |
$52K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
3,591 |
3,549 |
$52K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
779 |
768 |
$52K |
| L3370 |
Sole wedge, between sole |
1,571 |
1,056 |
$52K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,684 |
1,683 |
$50K |
| L3962 |
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment |
120 |
120 |
$50K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,784 |
2,700 |
$49K |
| A4456 |
Adhesive remover, wipes, any type, each |
6,528 |
6,264 |
$49K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
1,419 |
998 |
$48K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,270 |
3,159 |
$47K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
7,493 |
7,407 |
$47K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,070 |
1,028 |
$47K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
680 |
671 |
$46K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
721 |
688 |
$45K |
| E0271 |
Mattress, innerspring |
705 |
699 |
$44K |
| B4100 |
Food thickener, administered orally, per ounce |
1,060 |
1,022 |
$43K |
| L1850 |
Knee orthosis, swedish type, prefabricated, off-the-shelf |
258 |
172 |
$41K |
| L3982 |
Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment |
140 |
137 |
$41K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
781 |
749 |
$41K |
| L0180 |
Cervical, multiple post collar, occipital/mandibular supports, adjustable |
253 |
253 |
$40K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
972 |
921 |
$40K |
| K0002 |
Standard hemi (low seat) wheelchair |
1,980 |
1,939 |
$39K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
2,128 |
1,838 |
$39K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
536 |
476 |
$38K |
| A4452 |
Tape, waterproof, per 18 square inches |
4,901 |
4,701 |
$38K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
5,315 |
5,092 |
$37K |
| K0004 |
High strength, lightweight wheelchair |
387 |
387 |
$36K |
| L2780 |
Addition to lower extremity orthosis, non-corrosive finish, per bar |
312 |
203 |
$36K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
79 |
72 |
$34K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
39 |
37 |
$34K |
| E0776 |
Iv pole |
904 |
876 |
$33K |
| L0624 |
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated |
209 |
209 |
$32K |
| E0745 |
Neuromuscular stimulator, electronic shock unit |
240 |
239 |
$31K |
| E1810 |
Dynamic adjustable knee extension and flexion device, includes soft interface material |
90 |
68 |
$30K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
716 |
704 |
$30K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
4,132 |
4,113 |
$30K |
| E0656 |
Segmental pneumatic appliance for use with pneumatic compressor, trunk |
843 |
843 |
$30K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
358 |
326 |
$28K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
495 |
477 |
$27K |
| L3762 |
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
492 |
248 |
$27K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
203 |
200 |
$26K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
614 |
541 |
$25K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
276 |
274 |
$24K |
| L0651 |
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf |
51 |
51 |
$24K |
| L5986 |
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
72 |
62 |
$24K |
| K0857 |
Power wheelchair, group 3 standard, single power option, captains chair, patient weight capacity up to and including 300 pounds |
37 |
37 |
$24K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
887 |
879 |
$23K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
296 |
276 |
$23K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
483 |
458 |
$23K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
615 |
314 |
$22K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,320 |
7,215 |
$22K |
| L8310 |
Truss, double with standard pads |
242 |
237 |
$21K |
| A4623 |
Tracheostomy, inner cannula |
291 |
263 |
$21K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
217 |
190 |
$21K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
7,476 |
3,683 |
$20K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
283 |
244 |
$20K |
| E0245 |
Tub stool or bench |
1,252 |
1,186 |
$20K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
239 |
238 |
$19K |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
436 |
267 |
$19K |
| L1300 |
Other scoliosis procedure, body jacket molded to patient model |
13 |
13 |
$19K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,257 |
1,135 |
$18K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
8,227 |
8,170 |
$18K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
183 |
183 |
$18K |
| E0274 |
Over-bed table |
473 |
468 |
$18K |
| A7525 |
Tracheostomy mask, each |
4,129 |
4,069 |
$18K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
231 |
220 |
$17K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
128 |
128 |
$17K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,220 |
3,111 |
$16K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
1,359 |
1,298 |
$16K |
| L3260 |
Surgical boot/shoe, each |
1,195 |
1,130 |
$16K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,563 |
1,558 |
$16K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
214 |
183 |
$16K |
| L2810 |
Addition to lower extremity orthosis, knee control, condylar pad |
154 |
139 |
$16K |
| L4397 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
161 |
81 |
$15K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,100 |
1,057 |
$14K |
| L3225 |
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
328 |
164 |
$14K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
32 |
27 |
$14K |
| E0215 |
Electric heat pad, moist |
563 |
561 |
$14K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
14 |
13 |
$14K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
94 |
94 |
$13K |
| A4231 |
Infusion set for external insulin pump, needle type |
98 |
97 |
$13K |
| A4481 |
Tracheostoma filter, any type, any size, each |
215 |
212 |
$13K |
| L2300 |
Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable |
72 |
68 |
$13K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
787 |
756 |
$13K |
| E0650 |
Pneumatic compressor, non-segmental home model |
79 |
79 |
$13K |
| L5651 |
Addition to lower extremity, above knee, flexible inner socket, external frame |
25 |
25 |
$13K |
| A4371 |
Ostomy skin barrier, powder, per oz |
3,273 |
3,156 |
$12K |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
34 |
17 |
$12K |
| L0628 |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
228 |
226 |
$12K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
162 |
105 |
$12K |
| A4322 |
Irrigation syringe, bulb or piston, each |
520 |
498 |
$12K |
| 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) |
65 |
65 |
$11K |
| 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 |
62 |
60 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
11,629 |
11,455 |
$11K |
| L2640 |
Addition to lower extremity, pelvic control, band and belt, bilateral |
39 |
39 |
$11K |
| 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 |
410 |
409 |
$11K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
490 |
484 |
$11K |
| L0641 |
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
246 |
246 |
$11K |
| A4384 |
Ostomy faceplate equivalent, silicone ring, each |
254 |
249 |
$11K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
39 |
39 |
$11K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
60 |
60 |
$10K |
| L5649 |
Addition to lower extremity, ischial containment/narrow m-l socket |
12 |
12 |
$10K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
344 |
335 |
$9K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,414 |
2,287 |
$9K |
| K0040 |
Adjustable angle footplate, each |
101 |
79 |
$9K |
| E0246 |
Transfer tub rail attachment |
225 |
225 |
$9K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
295 |
285 |
$9K |
| A6583 |
Gradient compression wrap with adjustable straps, below knee, each |
75 |
38 |
$9K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
1,005 |
997 |
$9K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,862 |
1,806 |
$8K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
111 |
109 |
$8K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
271 |
263 |
$8K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,820 |
1,726 |
$8K |
| A4367 |
Ostomy belt, each |
1,492 |
1,452 |
$8K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
1,203 |
1,153 |
$8K |
| L1831 |
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
56 |
31 |
$8K |
| E0301 |
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, without mattress |
80 |
80 |
$6K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
436 |
425 |
$6K |
| A5501 |
For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe |
54 |
43 |
$6K |
| A4630 |
Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient |
2,982 |
2,939 |
$6K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
121 |
78 |
$6K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
107 |
96 |
$6K |
| A6235 |
Hydrocolloid 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 |
28 |
27 |
$6K |
| A4332 |
Lubricant, individual sterile packet, each |
678 |
631 |
$6K |
| L5647 |
Addition to lower extremity, below knee suction socket |
13 |
13 |
$6K |
| A6534 |
Gradient compression stocking, thigh length, 30-40 mmhg, each |
103 |
99 |
$5K |
| K0806 |
Power operated vehicle, group 2 standard, patient weight capacity up to and including 300 pounds |
13 |
13 |
$5K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
136 |
72 |
$5K |
| 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 |
88 |
86 |
$5K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
27 |
25 |
$5K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
17 |
12 |
$5K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
28 |
25 |
$5K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
96 |
62 |
$5K |
| E0154 |
Platform attachment, walker, each |
81 |
81 |
$5K |
| E0956 |
Wheelchair accessory, lateral trunk or hip support, any type, including fixed mounting hardware, each |
34 |
28 |
$4K |
| K0007 |
Extra heavy duty wheelchair |
58 |
58 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
19 |
13 |
$4K |
| L2768 |
Orthotic side bar disconnect device, per bar |
61 |
32 |
$4K |
| L5650 |
Additions to lower extremity, total contact, above knee or knee disarticulation socket |
12 |
12 |
$4K |
| L8501 |
Tracheostomy speaking valve |
65 |
63 |
$4K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
207 |
205 |
$4K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
83 |
80 |
$4K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
15 |
14 |
$4K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
53 |
52 |
$4K |
| L3420 |
Full sole and heel wedge, between sole |
122 |
61 |
$4K |
| L0456 |
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$3K |
| L3520 |
Orthopedic shoe addition, insole, felt covered with leather |
193 |
96 |
$3K |
| E0210 |
Electric heat pad, standard |
459 |
459 |
$3K |
| A4258 |
Spring-powered device for lancet, each |
2,157 |
2,147 |
$3K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
66 |
66 |
$3K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
135 |
125 |
$3K |
| E0110 |
Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips |
55 |
55 |
$3K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
88 |
87 |
$2K |
| B4082 |
Nasogastric tubing without stylet |
243 |
208 |
$2K |
| A4557 |
Lead wires, (e.g., apnea monitor), per pair |
568 |
566 |
$2K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
79 |
79 |
$2K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
265 |
265 |
$2K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
69 |
65 |
$2K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
41 |
41 |
$2K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
305 |
301 |
$2K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
82 |
79 |
$2K |
| L0623 |
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
15 |
13 |
$2K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
95 |
94 |
$2K |
| A5126 |
Adhesive or non-adhesive; disk or foam pad |
79 |
76 |
$2K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
13 |
13 |
$2K |
| L4210 |
Repair of orthotic device, repair or replace minor parts |
28 |
14 |
$2K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
28 |
26 |
$2K |
| L3070 |
Foot, arch support, non-removable attached to shoe, longitudinal, each |
63 |
32 |
$1K |
| L3150 |
Foot, abduction rotation bar, without shoes |
31 |
30 |
$1K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
16 |
14 |
$1K |
| E2367 |
Power wheelchair accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each |
12 |
12 |
$1K |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
13 |
13 |
$1K |
| A4930 |
Gloves, sterile, per pair |
28 |
25 |
$1K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
37 |
37 |
$1K |
| A7012 |
Water collection device, used with large volume nebulizer |
297 |
294 |
$1K |
| L1240 |
Addition to tlso, (low profile), lumbar derotation pad |
16 |
12 |
$1K |
| E2397 |
Power wheelchair accessory, lithium-based battery, each |
15 |
15 |
$985.33 |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
27 |
24 |
$969.84 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
344 |
317 |
$945.46 |
| L8440 |
Prosthetic shrinker, below knee, each |
17 |
12 |
$922.98 |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
17 |
14 |
$921.48 |
| A4614 |
Peak expiratory flow rate meter, hand held |
42 |
42 |
$722.82 |
| B4081 |
Nasogastric tubing with stylet |
56 |
53 |
$643.11 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
84 |
84 |
$629.46 |
| E0305 |
Bed side rails, half length |
26 |
26 |
$596.34 |
| L0984 |
Protective body sock, prefabricated, off-the-shelf, each |
13 |
13 |
$587.90 |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
13 |
13 |
$452.30 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
27 |
25 |
$418.38 |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
12 |
12 |
$401.63 |
| E0315 |
Bed accessory: board, table, or support device, any type |
12 |
12 |
$362.09 |
| E0159 |
Brake attachment for wheeled walker, replacement, each |
97 |
60 |
$309.10 |
| A4565 |
Slings |
58 |
57 |
$270.84 |
| E0605 |
Vaporizer, room type |
24 |
24 |
$240.90 |
| E0325 |
Urinal; male, jug-type, any material |
112 |
112 |
$197.59 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
501 |
496 |
$138.60 |
| A4618 |
Breathing circuits |
30 |
29 |
$112.89 |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
25 |
25 |
$90.24 |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
55 |
55 |
$30.42 |
| E0235 |
Paraffin bath unit, portable (see medical supply code a4265 for paraffin) |
29 |
25 |
$13.59 |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
13 |
13 |
$7.87 |
| A4931 |
Oral thermometer, reusable, any type, each |
14 |
14 |
$5.01 |
| A4510 |
Surgical stockings full length, each |
108 |
28 |
$0.00 |
| 99080 |
|
4,290 |
2,559 |
$0.00 |