| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
26,013 |
19,346 |
$3.37M |
| 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 |
9,077 |
5,609 |
$2.33M |
| 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 |
3,975 |
3,145 |
$1.30M |
| 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 |
8,731 |
6,007 |
$1.07M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13,714 |
8,893 |
$834K |
| 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 |
5,445 |
3,694 |
$716K |
| 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 |
7,005 |
3,587 |
$588K |
| 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 |
1,253 |
908 |
$478K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
24,994 |
3,576 |
$322K |
| 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 |
1,480 |
918 |
$302K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,728 |
2,628 |
$292K |
| S9500 |
Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
772 |
293 |
$227K |
| 99601 |
|
1,574 |
605 |
$169K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
17,442 |
2,240 |
$134K |
| 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 |
1,046 |
722 |
$72K |
| 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 |
2,400 |
1,843 |
$65K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
6,865 |
5,671 |
$63K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
823 |
281 |
$57K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,209 |
705 |
$39K |
| E0776 |
Iv pole |
535 |
464 |
$31K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
4,585 |
3,053 |
$20K |
| S1015 |
Iv tubing extension set |
2,020 |
815 |
$11K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,809 |
1,502 |
$10K |
| A4452 |
Tape, waterproof, per 18 square inches |
4,630 |
4,060 |
$10K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,906 |
1,518 |
$10K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
2,227 |
877 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,714 |
1,472 |
$4K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
376 |
137 |
$2K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
110 |
87 |
$2K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
1,066 |
281 |
$1K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
636 |
342 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
20 |
13 |
$144.77 |
| A4402 |
Lubricant, per ounce |
78 |
70 |
$4.14 |
| A9270 |
Non-covered item or service |
89 |
44 |
$0.00 |