| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
41,489 |
39,267 |
$1.60M |
| 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 |
7,710 |
4,323 |
$383K |
| 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 |
7,737 |
4,344 |
$335K |
| 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 |
1,221 |
1,219 |
$274K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
4,218 |
3,746 |
$233K |
| A4670 |
Automatic blood pressure monitor |
4,098 |
4,083 |
$204K |
| A4259 |
Lancets, per box of 100 |
40,983 |
38,780 |
$200K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
2,346 |
2,116 |
$180K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,693 |
2,509 |
$126K |
| A4245 |
Alcohol wipes, per box |
39,813 |
37,620 |
$123K |
| 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 |
1,556 |
1,470 |
$102K |
| A6536 |
Gradient compression stocking, full length/chap style, 18-30 mmhg, each |
839 |
807 |
$101K |
| E0570 |
Nebulizer, with compressor |
5,082 |
5,052 |
$100K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,449 |
3,419 |
$88K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,564 |
1,546 |
$68K |
| K0003 |
Lightweight wheelchair |
2,524 |
2,442 |
$60K |
| A4928 |
Surgical mask, per 20 |
2,256 |
2,252 |
$58K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,063 |
1,063 |
$35K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
2,112 |
2,092 |
$25K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
905 |
893 |
$24K |
| 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 |
444 |
345 |
$20K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,438 |
1,432 |
$16K |
| 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 |
376 |
330 |
$14K |
| A7030 |
Full face mask used with positive airway pressure device, each |
200 |
197 |
$14K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
407 |
342 |
$13K |
| A4256 |
Normal, low and high calibrator solution / chips |
2,623 |
2,568 |
$12K |
| 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 |
1,280 |
1,277 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,051 |
1,025 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
343 |
339 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
238 |
235 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,837 |
1,284 |
$4K |
| E0156 |
Seat attachment, walker |
589 |
588 |
$4K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
2,807 |
1,928 |
$4K |
| A7031 |
Face mask interface, replacement for full face mask, each |
95 |
92 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
485 |
471 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
229 |
218 |
$2K |
| E0607 |
Home blood glucose monitor |
236 |
232 |
$2K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
25 |
25 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
149 |
135 |
$1K |
| E1392 |
Portable oxygen concentrator, rental |
232 |
232 |
$1K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
391 |
199 |
$934.45 |
| A7015 |
Aerosol mask, used with dme nebulizer |
947 |
938 |
$800.35 |
| L0120 |
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
50 |
50 |
$695.14 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
62 |
62 |
$695.01 |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
53 |
53 |
$327.68 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
53 |
53 |
$272.50 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
558 |
526 |
$221.87 |
| A4258 |
Spring-powered device for lancet, each |
118 |
118 |
$50.08 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
15 |
15 |
$16.50 |