| 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 |
232,669 |
225,592 |
$11.35M |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
10,417 |
10,055 |
$10.32M |
| T4541 |
Incontinence product, disposable underpad, large, each |
335,012 |
330,841 |
$7.86M |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
130,583 |
128,632 |
$4.57M |
| K0001 |
Standard wheelchair |
191,523 |
189,074 |
$4.08M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
159,697 |
153,920 |
$3.26M |
| E0601 |
Continuous positive airway pressure (cpap) device |
183,439 |
182,209 |
$3.16M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
51,011 |
49,879 |
$3.07M |
| E0277 |
Powered pressure-reducing air mattress |
10,773 |
10,565 |
$3.01M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
90,401 |
89,064 |
$2.99M |
| E1399 |
Durable medical equipment, miscellaneous |
25,081 |
22,352 |
$2.91M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
64,220 |
63,426 |
$2.85M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
22,471 |
21,617 |
$2.81M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,711 |
2,750 |
$2.35M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
223,734 |
221,035 |
$2.25M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
87,161 |
85,765 |
$2.14M |
| 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) |
11,196 |
11,109 |
$2.05M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
59,596 |
58,669 |
$2.02M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
36,579 |
35,383 |
$1.96M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
58,544 |
57,892 |
$1.88M |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
62,065 |
61,112 |
$1.86M |
| E0570 |
Nebulizer, with compressor |
31,784 |
30,792 |
$1.68M |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
38,083 |
37,723 |
$1.66M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
36,750 |
36,222 |
$1.60M |
| A4322 |
Irrigation syringe, bulb or piston, each |
39,026 |
38,030 |
$1.50M |
| 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) |
28,587 |
28,351 |
$1.48M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
37,025 |
36,540 |
$1.35M |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
225,609 |
223,879 |
$1.32M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
3,618 |
3,503 |
$1.32M |
| B9002 |
Enteral nutrition infusion pump, any type |
19,757 |
19,498 |
$1.28M |
| B9998 |
Noc for enteral supplies |
42,829 |
39,463 |
$1.25M |
| T5999 |
Supply, not otherwise specified |
13,597 |
11,814 |
$1.18M |
| A4649 |
Surgical supply; miscellaneous |
34,339 |
32,875 |
$926K |
| A4670 |
Automatic blood pressure monitor |
23,823 |
23,506 |
$924K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,045 |
1,009 |
$900K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
3,383 |
3,243 |
$849K |
| K0003 |
Lightweight wheelchair |
27,769 |
27,433 |
$846K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
15,008 |
14,674 |
$802K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
19,076 |
18,791 |
$765K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
10,115 |
9,893 |
$749K |
| 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 |
6,132 |
6,056 |
$702K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
17,400 |
17,258 |
$682K |
| E0245 |
Tub stool or bench |
23,791 |
22,877 |
$671K |
| 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 |
10,847 |
9,886 |
$670K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
87,400 |
86,384 |
$653K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
4,206 |
1,531 |
$600K |
| E1392 |
Portable oxygen concentrator, rental |
11,590 |
11,433 |
$591K |
| A7030 |
Full face mask used with positive airway pressure device, each |
18,068 |
17,904 |
$586K |
| A4927 |
Gloves, non-sterile, per 100 |
84,111 |
81,824 |
$575K |
| K0006 |
Heavy duty wheelchair |
11,784 |
11,634 |
$529K |
| E0935 |
Continuous passive motion exercise device for use on knee only |
2,186 |
2,119 |
$512K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
55,109 |
54,129 |
$488K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
58,601 |
55,053 |
$461K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
20,970 |
20,785 |
$454K |
| K0007 |
Extra heavy duty wheelchair |
5,693 |
5,600 |
$451K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
12,491 |
11,912 |
$421K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
21,883 |
21,515 |
$409K |
| 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 |
2,318 |
2,211 |
$396K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
4,573 |
4,313 |
$394K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
3,664 |
3,595 |
$382K |
| A4623 |
Tracheostomy, inner cannula |
4,336 |
4,164 |
$374K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
12,404 |
12,247 |
$370K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
15,633 |
15,054 |
$365K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
7,182 |
6,978 |
$353K |
| 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 |
7,617 |
6,832 |
$349K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
14,871 |
14,338 |
$347K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
9,428 |
9,220 |
$327K |
| A4335 |
Incontinence supply; miscellaneous |
79,256 |
78,342 |
$323K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
18,818 |
18,233 |
$317K |
| A4217 |
Sterile water/saline, 500 ml |
16,245 |
15,804 |
$309K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
492 |
450 |
$287K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
2,255 |
2,137 |
$272K |
| A7035 |
Headgear used with positive airway pressure device |
39,346 |
38,960 |
$270K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,757 |
2,491 |
$260K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
307 |
301 |
$260K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
1,017 |
961 |
$255K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,910 |
5,786 |
$255K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
10,476 |
10,373 |
$254K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,685 |
1,484 |
$254K |
| E0271 |
Mattress, innerspring |
36,391 |
35,980 |
$252K |
| E0310 |
Bed side rails, full length |
35,137 |
34,792 |
$246K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
9,666 |
9,491 |
$237K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
4,236 |
4,062 |
$234K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
11,849 |
11,717 |
$229K |
| A7000 |
Canister, disposable, used with suction pump, each |
12,046 |
8,955 |
$226K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
2,826 |
2,686 |
$217K |
| A7526 |
Tracheostomy tube collar/holder, each |
6,862 |
6,677 |
$212K |
| A7037 |
Tubing used with positive airway pressure device |
33,501 |
33,241 |
$211K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
35,247 |
31,853 |
$206K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,988 |
2,861 |
$197K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
4,175 |
4,026 |
$195K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
6,567 |
6,391 |
$187K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
4,852 |
4,733 |
$184K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,594 |
3,460 |
$180K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,618 |
1,573 |
$180K |
| 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 |
8,032 |
7,754 |
$172K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,673 |
2,609 |
$165K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,017 |
991 |
$158K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
3,005 |
2,930 |
$158K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
1,963 |
1,928 |
$156K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
4,239 |
4,049 |
$144K |
| E0156 |
Seat attachment, walker |
23,675 |
23,389 |
$142K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
4,434 |
4,350 |
$142K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
11,342 |
10,937 |
$142K |
| E0776 |
Iv pole |
14,785 |
14,403 |
$141K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
3,309 |
3,260 |
$140K |
| A6210 |
Foam 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 |
1,360 |
1,314 |
$140K |
| A4421 |
Ostomy supply; miscellaneous |
1,817 |
1,687 |
$138K |
| A5120 |
Skin barrier, wipes or swabs, each |
19,371 |
18,925 |
$135K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,810 |
2,734 |
$134K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
16,785 |
16,581 |
$131K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
1,416 |
1,273 |
$127K |
| A4456 |
Adhesive remover, wipes, any type, each |
17,701 |
17,366 |
$118K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
782 |
750 |
$118K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
1,272 |
1,261 |
$114K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
10,407 |
10,127 |
$109K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
5,243 |
4,945 |
$106K |
| E0635 |
Patient lift, electric with seat or sling |
1,487 |
1,460 |
$103K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,774 |
4,740 |
$103K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
36,452 |
35,489 |
$101K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,508 |
1,274 |
$100K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
4,326 |
4,247 |
$98K |
| K0004 |
High strength, lightweight wheelchair |
2,768 |
2,747 |
$98K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
4,602 |
4,462 |
$97K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
6,486 |
6,291 |
$94K |
| 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 |
8,912 |
8,077 |
$93K |
| 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 |
3,344 |
2,831 |
$92K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
8,804 |
8,543 |
$90K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
7,223 |
7,058 |
$87K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
1,211 |
1,183 |
$87K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,016 |
1,908 |
$86K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
22,083 |
21,603 |
$86K |
| E0168 |
Commode chair, extra wide and/or heavy duty, stationary or mobile, with or without arms, any type, each |
1,540 |
1,510 |
$84K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,896 |
1,825 |
$83K |
| E0244 |
Raised toilet seat |
2,889 |
2,840 |
$83K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,740 |
1,713 |
$83K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
691 |
642 |
$82K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
4,134 |
4,095 |
$82K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,919 |
1,867 |
$77K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
43,154 |
42,730 |
$77K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,628 |
1,572 |
$72K |
| E1236 |
Wheelchair, pediatric size, folding, adjustable, with seating system |
160 |
157 |
$71K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
11,268 |
10,686 |
$69K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,059 |
1,035 |
$67K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
3,273 |
3,225 |
$63K |
| A4371 |
Ostomy skin barrier, powder, per oz |
10,051 |
9,902 |
$63K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
10,097 |
9,931 |
$59K |
| S9999 |
Sales tax |
23,549 |
21,473 |
$56K |
| A6260 |
Wound cleansers, any type, any size |
1,885 |
1,840 |
$56K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
737 |
726 |
$55K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
8,153 |
8,012 |
$55K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
4,511 |
4,482 |
$50K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,777 |
1,707 |
$50K |
| A4657 |
Syringe, with or without needle, each |
23,039 |
15,479 |
$47K |
| A4452 |
Tape, waterproof, per 18 square inches |
4,862 |
4,761 |
$44K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
3,958 |
3,939 |
$43K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,726 |
1,702 |
$42K |
| A4245 |
Alcohol wipes, per box |
20,624 |
20,326 |
$41K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
1,281 |
1,246 |
$41K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
14,492 |
14,356 |
$40K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
11,301 |
10,228 |
$39K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
2,059 |
1,974 |
$39K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,048 |
2,010 |
$39K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,264 |
1,225 |
$38K |
| A4402 |
Lubricant, per ounce |
10,826 |
10,589 |
$37K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,102 |
1,034 |
$36K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
4,195 |
4,105 |
$35K |
| E0305 |
Bed side rails, half length |
4,859 |
4,829 |
$35K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
518 |
353 |
$35K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
786 |
750 |
$33K |
| E2603 |
Skin protection wheelchair seat cushion, width less than 22 inches, any depth |
1,602 |
1,581 |
$33K |
| A4605 |
Tracheal suction catheter, closed system, each |
723 |
699 |
$32K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,947 |
1,923 |
$32K |
| E0241 |
Bath tub wall rail, each |
2,951 |
2,516 |
$31K |
| E0297 |
Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress |
1,036 |
1,035 |
$30K |
| 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 |
298 |
292 |
$29K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
307 |
299 |
$28K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
879 |
855 |
$28K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
241 |
239 |
$26K |
| E1639 |
Scale, each |
540 |
538 |
$24K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
886 |
866 |
$23K |
| A4367 |
Ostomy belt, each |
4,285 |
4,180 |
$23K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
5,498 |
5,439 |
$21K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,183 |
1,153 |
$20K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
1,208 |
1,179 |
$20K |
| E2209 |
Accessory, arm trough, with or without hand support, each |
1,704 |
1,663 |
$19K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,735 |
3,697 |
$19K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
2,078 |
2,016 |
$18K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
344 |
341 |
$16K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
330 |
329 |
$16K |
| E0243 |
Toilet rail, each |
617 |
609 |
$15K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
1,657 |
1,646 |
$15K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
265 |
257 |
$15K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,508 |
1,479 |
$13K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,818 |
1,787 |
$13K |
| A4246 |
Betadine or phisohex solution, per pint |
1,595 |
1,561 |
$12K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
185 |
184 |
$12K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
895 |
865 |
$12K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
545 |
428 |
$11K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,369 |
3,282 |
$10K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
1,722 |
1,706 |
$9K |
| A7525 |
Tracheostomy mask, each |
2,538 |
2,438 |
$9K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
127 |
93 |
$9K |
| K0040 |
Adjustable angle footplate, each |
162 |
131 |
$8K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
251 |
250 |
$8K |
| A4332 |
Lubricant, individual sterile packet, each |
2,606 |
2,551 |
$7K |
| E0705 |
Transfer device, any type, each |
260 |
254 |
$7K |
| A7036 |
Chinstrap used with positive airway pressure device |
1,156 |
1,145 |
$7K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
585 |
568 |
$6K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
1,168 |
1,157 |
$6K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
3,093 |
2,769 |
$6K |
| E1232 |
Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system |
65 |
65 |
$6K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,185 |
2,180 |
$5K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
41 |
38 |
$5K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
45 |
45 |
$5K |
| E0154 |
Platform attachment, walker, each |
189 |
163 |
$5K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
70 |
70 |
$4K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
222 |
216 |
$4K |
| E2374 |
Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
29 |
25 |
$4K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
138 |
133 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
420 |
393 |
$4K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
196 |
190 |
$3K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
39 |
36 |
$3K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
185 |
184 |
$3K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
128 |
127 |
$3K |
| A7012 |
Water collection device, used with large volume nebulizer |
537 |
511 |
$3K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
94 |
93 |
$3K |
| A4259 |
Lancets, per box of 100 |
534 |
420 |
$3K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
191 |
188 |
$3K |
| B4081 |
Nasogastric tubing with stylet |
437 |
421 |
$3K |
| E1039 |
Transport chair, adult size, heavy duty, patient weight capacity greater than 300 pounds |
139 |
139 |
$2K |
| A6455 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard |
50 |
49 |
$2K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
490 |
478 |
$2K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
64 |
64 |
$2K |
| E0621 |
Sling or seat, patient lift, canvas or nylon |
462 |
460 |
$2K |
| 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 |
12 |
12 |
$2K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
37 |
36 |
$2K |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
327 |
314 |
$2K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
366 |
358 |
$2K |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
40 |
40 |
$1K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13 |
12 |
$1K |
| E0246 |
Transfer tub rail attachment |
970 |
941 |
$1K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
14 |
14 |
$1K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
921 |
898 |
$1K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
40 |
37 |
$1K |
| 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 |
1,093 |
1,034 |
$1K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
278 |
274 |
$911.70 |
| E0950 |
Wheelchair accessory, tray, each |
28 |
28 |
$867.60 |
| E0940 |
Trapeze bar, free standing, complete with grab bar |
51 |
49 |
$815.82 |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
36 |
36 |
$758.81 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
96 |
95 |
$724.86 |
| A7015 |
Aerosol mask, used with dme nebulizer |
46 |
44 |
$585.43 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
135 |
133 |
$530.80 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
186 |
174 |
$516.02 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
24 |
24 |
$394.19 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
94 |
93 |
$277.93 |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
14 |
13 |
$169.90 |
| A6235 |
Hydrocolloid 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 |
12 |
12 |
$167.81 |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
12 |
12 |
$119.98 |
| K0053 |
Elevating footrests, articulating (telescoping), each |
13 |
13 |
$63.09 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
366 |
364 |
$16.12 |
| 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 |
52 |
52 |
$7.40 |
| B4100 |
Food thickener, administered orally, per ounce |
1,033 |
1,021 |
$0.00 |
| S9343 |
Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
850 |
846 |
$0.00 |
| 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 |
734 |
729 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
142 |
141 |
$0.00 |