B4162

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

HCPCS Coverage Code

D = Special coverage instructions apply

HCPCS Action Code

N = No maintenance for this code

HCPCS Action Effective Date

January 01, 2005

HCPCS Code Added Date

January 01, 2005

HCPCS Pricing Indicator Code

46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap – filled amounts)

HCPCS Multiple Pricing Indicator Code

A = Not applicable as HCPCS priced under one methodology

HCPCS Coverage Issues Manual Reference Section Number

65-10

HCPCS Type Of Service Code

E = Enteral/parenteral nutrients/supplies (eff 04/95)

B4162

Short Description

HCPCS Coverage Code

HCPCS Action Code

HCPCS Action Effective Date

HCPCS Code Added Date

HCPCS Pricing Indicator Code

HCPCS Multiple Pricing Indicator Code

HCPCS Coverage Issues Manual Reference Section Number

HCPCS Type Of Service Code

HCPCS Anesthesia Base Unit Quantity