B4154
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
Short Description
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Ef spec metabolic noninherit
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, 1984
HCPCS Pricing Indicator Code
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39 = Parenteral and Enteral Nutrition
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 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