| 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 |
16,500 |
14,286 |
$541K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,085 |
1,750 |
$81K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,660 |
8,448 |
$80K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,164 |
2,796 |
$79K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,354 |
1,131 |
$32K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,159 |
1,006 |
$22K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,691 |
1,502 |
$21K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,008 |
930 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
1,978 |
1,688 |
$16K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,436 |
4,823 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
2,555 |
2,159 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
2,601 |
2,219 |
$13K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
439 |
364 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,419 |
1,219 |
$5K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
49 |
41 |
$5K |
| E0570 |
Nebulizer, with compressor |
1,447 |
1,263 |
$5K |
| 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) |
83 |
69 |
$5K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
263 |
221 |
$3K |
| 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 |
24 |
24 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
311 |
219 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
416 |
317 |
$432.02 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
174 |
130 |
$391.52 |