Table of content for "Ef ped specmetabolic inherit" (HCPCS B4162)
General information on the “B4162” code
HCPCS Code: B4162
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
Short Description: Ef ped specmetabolic inherit
Original information is taken from B4162 page
Pricing indicators
Pricing Indicator Code 1: 46 – Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts). 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: 20050101
Code Effective Date: 20050101
Action Code: N – No maintenance for this code