| 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 |
1,446 |
1,063 |
$34K |
| 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 |
848 |
579 |
$19K |
| 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 |
474 |
376 |
$11K |
| 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 |
194 |
126 |
$7K |
| A4623 |
Tracheostomy, inner cannula |
238 |
228 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,154 |
1,110 |
$1K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
66 |
40 |
$784.20 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
14 |
14 |
$732.33 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
457 |
449 |
$531.95 |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
354 |
354 |
$438.24 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
871 |
855 |
$436.96 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
163 |
163 |
$427.69 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
16 |
12 |
$382.85 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
13 |
13 |
$374.59 |
| 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 |
36 |
34 |
$269.86 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
527 |
526 |
$235.15 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
65 |
53 |
$182.30 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
321 |
316 |
$122.05 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
13 |
$101.04 |
| A7526 |
Tracheostomy tube collar/holder, each |
200 |
195 |
$82.42 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
13 |
12 |
$75.28 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
356 |
350 |
$55.92 |