| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,553 |
2,279 |
$2.06M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,514 |
1,502 |
$1.36M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,604 |
10,517 |
$997K |
| 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 |
1,316 |
1,241 |
$604K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,315 |
2,094 |
$471K |
| 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 |
2,381 |
2,262 |
$335K |
| 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 |
1,115 |
692 |
$287K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,898 |
2,894 |
$249K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,408 |
1,210 |
$206K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
596 |
578 |
$169K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,239 |
1,080 |
$159K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,985 |
2,519 |
$143K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,384 |
6,364 |
$127K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,032 |
888 |
$110K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
3,224 |
3,201 |
$93K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
923 |
879 |
$88K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,032 |
864 |
$87K |
| A4605 |
Tracheal suction catheter, closed system, each |
813 |
760 |
$87K |
| 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 |
3,807 |
3,774 |
$84K |
| E0570 |
Nebulizer, with compressor |
1,713 |
1,663 |
$80K |
| A4927 |
Gloves, non-sterile, per 100 |
2,339 |
2,199 |
$65K |
| A4217 |
Sterile water/saline, 500 ml |
1,822 |
1,705 |
$54K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,954 |
2,831 |
$34K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
1,100 |
1,078 |
$31K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
273 |
264 |
$29K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,971 |
3,811 |
$28K |
| E0601 |
Continuous positive airway pressure (cpap) device |
746 |
742 |
$27K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
198 |
180 |
$27K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,458 |
1,371 |
$22K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,738 |
1,650 |
$22K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
130 |
128 |
$20K |
| A7002 |
Tubing, used with suction pump, each |
3,218 |
3,121 |
$11K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,899 |
2,828 |
$11K |
| K0001 |
Standard wheelchair |
339 |
339 |
$10K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,460 |
1,397 |
$9K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
251 |
248 |
$8K |
| A7030 |
Full face mask used with positive airway pressure device, each |
79 |
78 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
146 |
141 |
$6K |
| A7012 |
Water collection device, used with large volume nebulizer |
846 |
806 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
203 |
202 |
$4K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
625 |
609 |
$4K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
25 |
25 |
$3K |
| A4618 |
Breathing circuits |
88 |
76 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
242 |
242 |
$2K |
| 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 |
27 |
24 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
215 |
213 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,480 |
1,469 |
$2K |
| A7525 |
Tracheostomy mask, each |
1,149 |
1,070 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
420 |
407 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
29 |
29 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
127 |
126 |
$1K |
| 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 |
13 |
13 |
$1K |
| A4481 |
Tracheostoma filter, any type, any size, each |
377 |
367 |
$392.64 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
13 |
13 |
$219.66 |
| A4244 |
Alcohol or peroxide, per pint |
14 |
12 |
$29.46 |