B4103
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
Short Description
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Ef ped fluid and electrolyte
HCPCS Coverage Code
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D = Special coverage instructions apply
HCPCS Action Code
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N = No maintenance for this code
HCPCS Action Effective Date
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January 01, 2005
HCPCS Code Added Date
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January 01, 2005
HCPCS Pricing Indicator Code
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46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap – filled amounts)
HCPCS Multiple Pricing Indicator Code
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A = Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
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65-10
HCPCS Type Of Service Code
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E = Enteral/parenteral nutrients/supplies (eff 04/95)
HCPCS Anesthesia Base Unit Quantity
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0