| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
138,916 |
126,584 |
$7.64M |
| E0601 |
Continuous positive airway pressure (cpap) device |
109,353 |
102,096 |
$5.53M |
| 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) |
18,224 |
17,080 |
$2.20M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
3,500 |
3,224 |
$2.01M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
25,780 |
23,065 |
$1.73M |
| A7030 |
Full face mask used with positive airway pressure device, each |
28,266 |
24,605 |
$1.47M |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
41,267 |
36,463 |
$967K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
41,408 |
38,953 |
$931K |
| 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 |
38,138 |
34,124 |
$782K |
| E0570 |
Nebulizer, with compressor |
30,858 |
28,035 |
$760K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
23,029 |
20,374 |
$752K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
16,722 |
15,300 |
$711K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
6,221 |
6,186 |
$703K |
| E1392 |
Portable oxygen concentrator, rental |
40,787 |
37,086 |
$696K |
| K0001 |
Standard wheelchair |
22,686 |
20,871 |
$643K |
| A7031 |
Face mask interface, replacement for full face mask, each |
23,646 |
20,020 |
$621K |
| A7035 |
Headgear used with positive airway pressure device |
34,962 |
31,460 |
$596K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,387 |
4,619 |
$551K |
| 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 |
1,190 |
858 |
$494K |
| 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) |
2,399 |
2,210 |
$459K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
9,319 |
8,429 |
$360K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,899 |
2,044 |
$313K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
1,212 |
1,056 |
$276K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
10,896 |
9,380 |
$269K |
| K0007 |
Extra heavy duty wheelchair |
2,280 |
2,070 |
$253K |
| 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 |
1,904 |
1,396 |
$239K |
| 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 |
1,754 |
1,328 |
$205K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
9,059 |
7,817 |
$200K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
65,460 |
56,707 |
$174K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,473 |
1,400 |
$167K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
3,283 |
2,938 |
$167K |
| 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 |
1,585 |
1,198 |
$143K |
| 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 |
1,387 |
1,309 |
$132K |
| K0006 |
Heavy duty wheelchair |
1,785 |
1,639 |
$126K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
8,856 |
8,151 |
$113K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,259 |
1,119 |
$111K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
4,168 |
4,017 |
$107K |
| K0003 |
Lightweight wheelchair |
2,479 |
2,367 |
$105K |
| A7037 |
Tubing used with positive airway pressure device |
6,928 |
6,194 |
$97K |
| B9998 |
Noc for enteral supplies |
2,301 |
1,423 |
$80K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,370 |
2,102 |
$74K |
| 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 |
241 |
150 |
$73K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
245 |
221 |
$64K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,393 |
1,254 |
$63K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
835 |
759 |
$62K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
3,941 |
3,391 |
$62K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,195 |
938 |
$59K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
15,935 |
13,697 |
$57K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,273 |
1,098 |
$56K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
761 |
674 |
$53K |
| E0245 |
Tub stool or bench |
1,877 |
1,682 |
$51K |
| A4623 |
Tracheostomy, inner cannula |
876 |
732 |
$51K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
2,099 |
1,877 |
$51K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
854 |
675 |
$51K |
| 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 |
363 |
356 |
$50K |
| 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 |
177 |
145 |
$48K |
| E0248 |
Transfer bench, heavy duty, for tub or toilet with or without commode opening |
747 |
649 |
$48K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,400 |
1,236 |
$47K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,039 |
1,017 |
$47K |
| A4670 |
Automatic blood pressure monitor |
1,059 |
965 |
$47K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,115 |
959 |
$45K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,214 |
1,142 |
$43K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
500 |
439 |
$39K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
462 |
412 |
$36K |
| 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 |
395 |
259 |
$34K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,247 |
1,105 |
$34K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,876 |
6,124 |
$34K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,034 |
813 |
$34K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,026 |
789 |
$34K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
713 |
705 |
$31K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
214 |
210 |
$30K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
1,002 |
902 |
$28K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
357 |
296 |
$27K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
4,193 |
3,674 |
$27K |
| E0607 |
Home blood glucose monitor |
602 |
586 |
$25K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
452 |
439 |
$24K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,216 |
1,035 |
$24K |
| A4927 |
Gloves, non-sterile, per 100 |
2,289 |
1,971 |
$22K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
490 |
454 |
$21K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
79 |
78 |
$21K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
227 |
203 |
$19K |
| E0244 |
Raised toilet seat |
520 |
463 |
$18K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
989 |
515 |
$18K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
273 |
248 |
$18K |
| A7036 |
Chinstrap used with positive airway pressure device |
2,197 |
1,998 |
$16K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
554 |
472 |
$16K |
| 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 |
354 |
218 |
$15K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
179 |
163 |
$15K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
284 |
229 |
$14K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
106 |
98 |
$13K |
| E0156 |
Seat attachment, walker |
1,681 |
1,447 |
$12K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
10,039 |
9,180 |
$12K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,009 |
837 |
$10K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
93 |
85 |
$9K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
77 |
73 |
$9K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
26 |
24 |
$8K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
185 |
167 |
$8K |
| A4259 |
Lancets, per box of 100 |
928 |
916 |
$7K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
213 |
189 |
$7K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
562 |
504 |
$6K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
360 |
328 |
$6K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
228 |
173 |
$6K |
| E0776 |
Iv pole |
618 |
546 |
$5K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
648 |
535 |
$5K |
| 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 |
35 |
25 |
$5K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
119 |
103 |
$5K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
221 |
193 |
$5K |
| 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 |
111 |
88 |
$4K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
491 |
440 |
$4K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
48 |
41 |
$4K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
67 |
59 |
$4K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
225 |
200 |
$4K |
| A4322 |
Irrigation syringe, bulb or piston, each |
222 |
189 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
730 |
600 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
546 |
453 |
$3K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
69 |
59 |
$3K |
| E0277 |
Powered pressure-reducing air mattress |
15 |
14 |
$3K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
94 |
81 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,748 |
2,487 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
363 |
291 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
84 |
74 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
222 |
200 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
113 |
107 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
248 |
209 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
280 |
230 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
135 |
127 |
$1K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
33 |
28 |
$1K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
15 |
12 |
$747.42 |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
111 |
100 |
$743.46 |
| 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 |
14 |
12 |
$662.49 |
| A7525 |
Tracheostomy mask, each |
476 |
376 |
$580.42 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
88 |
87 |
$541.23 |
| L3260 |
Surgical boot/shoe, each |
12 |
12 |
$482.16 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
75 |
63 |
$409.43 |
| E0184 |
Dry pressure mattress |
91 |
85 |
$394.79 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
70 |
51 |
$340.61 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
110 |
74 |
$302.87 |
| A4371 |
Ostomy skin barrier, powder, per oz |
123 |
109 |
$293.94 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
85 |
71 |
$269.31 |
| E0241 |
Bath tub wall rail, each |
12 |
12 |
$264.00 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
14 |
14 |
$254.63 |
| A7012 |
Water collection device, used with large volume nebulizer |
150 |
120 |
$226.89 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
12 |
$219.83 |
| E0605 |
Vaporizer, room type |
12 |
12 |
$210.91 |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
17 |
14 |
$199.58 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
33 |
28 |
$178.79 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
16 |
12 |
$150.95 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,542 |
2,275 |
$147.73 |
| A4402 |
Lubricant, per ounce |
68 |
63 |
$144.74 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
14 |
13 |
$98.03 |
| E0305 |
Bed side rails, half length |
12 |
12 |
$68.63 |
| E1356 |
Oxygen accessory, battery pack/cartridge for portable concentrator, any type, replacement only, each |
4,209 |
4,196 |
$0.00 |