| 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 |
26,708 |
3,297 |
$784K |
| 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 |
2,528 |
1,185 |
$630K |
| B9998 |
Noc for enteral supplies |
3,029 |
2,487 |
$529K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
1,255 |
421 |
$278K |
| 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 |
1,931 |
958 |
$235K |
| B9002 |
Enteral nutrition infusion pump, any type |
934 |
910 |
$184K |
| S9342 |
Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
2,550 |
742 |
$167K |
| 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 |
1,343 |
236 |
$105K |
| 99601 |
|
2,547 |
928 |
$100K |
| 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 |
2,503 |
422 |
$98K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,183 |
1,011 |
$81K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,897 |
1,240 |
$80K |
| A4245 |
Alcohol wipes, per box |
800 |
337 |
$65K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
383 |
154 |
$61K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,344 |
365 |
$49K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
2,678 |
2,207 |
$35K |
| A4657 |
Syringe, with or without needle, each |
2,386 |
1,673 |
$26K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,006 |
772 |
$23K |
| 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 |
93 |
39 |
$11K |
| J1642 |
Injection, heparin sodium, (heparin lock flush), per 10 units |
1,395 |
423 |
$9K |
| A4217 |
Sterile water/saline, 500 ml |
1,046 |
439 |
$8K |
| A4452 |
Tape, waterproof, per 18 square inches |
696 |
591 |
$5K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
562 |
480 |
$4K |
| A4649 |
Surgical supply; miscellaneous |
126 |
114 |
$3K |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
179 |
25 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
106 |
102 |
$722.46 |
| 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 |
14 |
12 |
$404.57 |
| A4927 |
Gloves, non-sterile, per 100 |
46 |
43 |
$289.36 |