| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4223 |
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
23,919 |
19,026 |
$12.25M |
| S9374 |
Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
4,933 |
4,490 |
$1.11M |
| A4211 |
Supplies for self-administered injections |
3,042 |
1,911 |
$828K |
| 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 |
1,798 |
1,551 |
$627K |
| E0776 |
Iv pole |
4,056 |
3,701 |
$295K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
7,921 |
7,166 |
$270K |
| S9542 |
Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
2,352 |
1,546 |
$246K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
864 |
810 |
$156K |
| B9999 |
Noc for parenteral supplies |
2,884 |
2,663 |
$148K |
| S1015 |
Iv tubing extension set |
7,450 |
6,619 |
$89K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,523 |
1,795 |
$60K |
| S9379 |
Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
222 |
205 |
$56K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
1,742 |
1,209 |
$48K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
2,631 |
1,868 |
$36K |
| A4927 |
Gloves, non-sterile, per 100 |
9,821 |
8,692 |
$16K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
5,192 |
4,315 |
$13K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
2,809 |
2,609 |
$6K |
| A4245 |
Alcohol wipes, per box |
12,290 |
10,591 |
$5K |
| E0781 |
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
378 |
53 |
$2K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50 |
16 |
$844.79 |
| A9270 |
Non-covered item or service |
127 |
111 |
$296.93 |
| A4215 |
Needle, sterile, any size, each |
384 |
346 |
$55.74 |
| A4860 |
Disposable catheter tips for peritoneal dialysis, per 10 |
150 |
122 |
$41.40 |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
248 |
225 |
$29.10 |
| A4452 |
Tape, waterproof, per 18 square inches |
89 |
72 |
$5.66 |