Showing codes B4104 (Additive for enteral formula (e.g., fiber)) — B4224 (Parenteral nutrition administration kit, per day)

B4104 - Additive for enteral formula
Long description: Additive for enteral formula (e.g., fiber)
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 00 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4105 - Enzyme cartridge enteral nut
Long description: In-line cartridge containing digestive enzyme(s) for enteral feeding, each
Code added date: 20190101.
Code effective date: 20190101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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B4148 - Enteral feed elastomer daily
Long description: Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
Code added date: 20231001.
Code effective date: 20231001.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4149 - Ef blenderized foods
Long description: Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
Code added date: 20050101.
Code effective date: 20060101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4150 - Ef complet w/intact nutrient
Long description: 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
Code added date: 19860101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4152 - Ef calorie dense>/=1.5kcal
Long description: 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
Code added date: 19840101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4153 - Ef hydrolyzed/amino acids
Long description: 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
Code added date: 19860101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4154 - Ef spec metabolic noninherit
Long description: 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
Code added date: 19840101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4155 - Ef incomplete/modular
Long description: 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
Code added date: 19860101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4157 - Ef special metabolic inherit
Long description: Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4158 - Ef ped complete intact nut
Long description: Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 46 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4159 - Ef ped complete soy based
Long description: Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 46 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4160 - Ef ped caloric dense>/=0.7kc
Long description: 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
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 46 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4161 - Ef ped hydrolyzed/amino acid
Long description: 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
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 46 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4162 - Ef ped specmetabolic inherit
Long description: Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
Code added date: 20050101.
Code effective date: 20050101.
Pricing Indicator Code(s): 46 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4164 - Parenteral 50% dextrose solu
Long description: Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix
Code added date: 19860101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4168 - Parenteral sol amino acid 3.
Long description: Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix
Code added date: 19840101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4172 - Parenteral sol amino acid 5.
Long description: Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix
Code added date: 19840101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4176 - Parenteral sol amino acid 7-
Long description: Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix
Code added date: 19860101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4178 - Parenteral sol amino acid >
Long description: Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix
Code added date: 19880101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4180 - Parenteral sol carb > 50%
Long description: Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix
Code added date: 19860101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4185 - Pn soln nos 10 grams lipids
Long description: Parenteral nutrition solution, not otherwise specified, 10 grams lipids
Code added date: 20060101.
Code effective date: 20200101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4187 - Omegaven, 10 grams lipids
Long description: Omegaven, 10 grams lipids
Code added date: 20200101.
Code effective date: 20200101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4189 - Parenteral sol amino acid &
Long description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix
Code added date: 19880101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4193 - Parenteral sol 52-73 gm prot
Long description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix
Code added date: 19880101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4197 - Parenteral sol 74-100 gm pro
Long description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix
Code added date: 19880101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4199 - Parenteral sol > 100gm prote
Long description: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix
Code added date: 19880101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4216 - Parenteral nutrition additiv
Long description: Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day
Code added date: 19840101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4220 - Parenteral supply kit premix
Long description: Parenteral nutrition supply kit; premix, per day
Code added date: 19840101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4222 - Parenteral supply kit homemi
Long description: Parenteral nutrition supply kit; home mix, per day
Code added date: 19860101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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B4224 - Parenteral administration ki
Long description: Parenteral nutrition administration kit, per day
Code added date: 19860101.
Code effective date: 20020101.
Pricing Indicator Code(s): 39 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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