| 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 |
6,499 |
4,118 |
$528K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12,103 |
10,259 |
$310K |
| 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 |
677 |
513 |
$286K |
| 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 |
1,999 |
1,444 |
$229K |
| 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 |
2,753 |
1,975 |
$148K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,210 |
2,017 |
$144K |
| 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 |
436 |
327 |
$109K |
| 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 |
1,639 |
1,213 |
$75K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,765 |
5,840 |
$39K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,394 |
1,210 |
$39K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,122 |
1,044 |
$20K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
760 |
590 |
$16K |
| E1392 |
Portable oxygen concentrator, rental |
1,078 |
1,012 |
$12K |
| E0776 |
Iv pole |
1,488 |
1,318 |
$6K |
| A7030 |
Full face mask used with positive airway pressure device, each |
180 |
169 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,621 |
2,374 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
1,027 |
948 |
$4K |
| E0570 |
Nebulizer, with compressor |
1,307 |
1,139 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
352 |
323 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
97 |
88 |
$1K |
| B9998 |
Noc for enteral supplies |
85 |
68 |
$889.61 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
40 |
36 |
$842.03 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
181 |
170 |
$754.00 |
| 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 |
27 |
24 |
$638.50 |
| E0601 |
Continuous positive airway pressure (cpap) device |
68 |
64 |
$638.36 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
897 |
797 |
$589.36 |
| A7526 |
Tracheostomy tube collar/holder, each |
27 |
24 |
$582.84 |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
14 |
12 |
$459.63 |
| K0001 |
Standard wheelchair |
34 |
26 |
$260.33 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
15 |
13 |
$11.26 |