| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
4,010 |
3,829 |
$2.06M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,566 |
9,049 |
$1.21M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,933 |
8,510 |
$1.14M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
8,969 |
8,506 |
$1.10M |
| A4927 |
Gloves, non-sterile, per 100 |
36,654 |
34,773 |
$964K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15,069 |
14,297 |
$769K |
| A4554 |
Disposable underpads, all sizes |
16,042 |
15,497 |
$642K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,202 |
3,962 |
$518K |
| T4541 |
Incontinence product, disposable underpad, large, each |
13,446 |
12,448 |
$510K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,554 |
10,793 |
$457K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,888 |
2,664 |
$398K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,746 |
3,541 |
$337K |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
1,265 |
1,180 |
$282K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,027 |
1,910 |
$276K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,861 |
1,675 |
$274K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,440 |
2,271 |
$255K |
| 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 |
9,735 |
7,549 |
$248K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,412 |
2,306 |
$230K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,418 |
1,286 |
$197K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,422 |
1,366 |
$168K |
| A4670 |
Automatic blood pressure monitor |
3,575 |
3,417 |
$158K |
| A4553 |
Non-disposable underpads, all sizes |
11,182 |
10,475 |
$158K |
| 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 |
6,152 |
4,178 |
$151K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
668 |
640 |
$150K |
| 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 |
2,878 |
2,198 |
$141K |
| 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 |
1,200 |
1,030 |
$138K |
| A4623 |
Tracheostomy, inner cannula |
4,454 |
3,792 |
$95K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,490 |
2,919 |
$92K |
| E0570 |
Nebulizer, with compressor |
6,764 |
6,114 |
$86K |
| A7526 |
Tracheostomy tube collar/holder, each |
4,818 |
4,114 |
$81K |
| B9002 |
Enteral nutrition infusion pump, any type |
4,426 |
3,951 |
$69K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,481 |
1,313 |
$54K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,627 |
1,477 |
$50K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
5,980 |
5,438 |
$45K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
991 |
802 |
$37K |
| A4238 |
Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
323 |
160 |
$35K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
466 |
412 |
$30K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
322 |
305 |
$30K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
981 |
834 |
$30K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,439 |
2,093 |
$26K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
996 |
856 |
$25K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,663 |
1,366 |
$25K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
386 |
347 |
$25K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
800 |
419 |
$25K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
854 |
744 |
$25K |
| K0001 |
Standard wheelchair |
1,461 |
1,372 |
$23K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,192 |
1,954 |
$23K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
855 |
782 |
$21K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,953 |
1,784 |
$21K |
| B9998 |
Noc for enteral supplies |
376 |
304 |
$19K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
372 |
347 |
$16K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
298 |
258 |
$15K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,261 |
1,156 |
$15K |
| A4259 |
Lancets, per box of 100 |
4,761 |
4,392 |
$14K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
927 |
856 |
$14K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
172 |
166 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
787 |
712 |
$12K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
600 |
310 |
$12K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
315 |
194 |
$12K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
181 |
170 |
$10K |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
29 |
28 |
$10K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,993 |
1,833 |
$9K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
645 |
589 |
$7K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
665 |
631 |
$7K |
| A4245 |
Alcohol wipes, per box |
1,633 |
1,439 |
$6K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
123 |
115 |
$6K |
| 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 |
14 |
12 |
$5K |
| E0156 |
Seat attachment, walker |
584 |
544 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
393 |
331 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,594 |
2,388 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
408 |
375 |
$3K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
72 |
67 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
84 |
51 |
$3K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
68 |
62 |
$3K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
164 |
155 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
94 |
85 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
179 |
159 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
27 |
24 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,682 |
1,564 |
$2K |
| 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 |
12 |
12 |
$2K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
69 |
60 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
191 |
166 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
48 |
48 |
$2K |
| A4663 |
Blood pressure cuff only |
313 |
290 |
$1K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$1K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
147 |
133 |
$1K |
| A4258 |
Spring-powered device for lancet, each |
639 |
603 |
$1K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
20 |
16 |
$1K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,273 |
2,131 |
$1K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
317 |
273 |
$754.86 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
564 |
519 |
$580.37 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
15 |
13 |
$329.59 |
| A4371 |
Ostomy skin barrier, powder, per oz |
37 |
36 |
$272.19 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
113 |
107 |
$129.60 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
50 |
36 |
$77.10 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
145 |
127 |
$57.81 |
| 0124A |
|
111 |
37 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
121 |
41 |
$0.00 |
| 90686 |
|
76 |
26 |
$0.00 |
| 90694 |
|
45 |
15 |
$0.00 |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
18 |
12 |
$0.00 |