B4155
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
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Ef incomplete/modular
HCPCS Coverage Code
-
D = Special coverage instructions apply
HCPCS Action Code
-
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, 1986
HCPCS Pricing Indicator Code
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39 = Parenteral and Enteral Nutrition
HCPCS Multiple Pricing Indicator Code
-
A = Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
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65-10
HCPCS Medicare Carriers Manual Reference Section Number
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2130, 4450
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