Table of content for "Ef incomplete/modular" (HCPCS B4155)
General information on the “B4155” code
HCPCS Code: B4155
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
Short Description: Ef incomplete/modular
Original information is taken from B4155 page
Pricing indicators
Pricing Indicator Code 1: 39 – Parenteral and Enteral Nutrition. Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings .
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage Issues Manual Reference Section Number 1: 65-10
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): O1C – Enteral and parenteral
Type Of Service 1: E – Enteral/parenteral nutrients/supplies (eff 04/95)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 19860101
Code Effective Date: 20050101
Action Code: N – No maintenance for this code