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B4104 - Additive for enteral formula

Navigation: HCPCS Codes > Codes with Prefix: B4
Field Value
HCPCS Code: B4104
Long Description: Additive for enteral formula (e.g. fiber)
Short Description: Additive for enteral formula
Pricing Indicator 1: 00 (Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.))
Multiple Pricing Code: 9 (Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is 99))
Coverage Issues Manual 1: 65-10
Statute Number:
Coverage Code: D (Special coverage instructions apply)
ASC Payment Group Code:
Processing Note Number:
Berenson-Eggers Type of Service (BETOS) Code: O1C (Enteral and parenteral)
Type of Service Code 1: E (Enteral/parenteral nutrients/supplies (effective 04/95))
Anesthesia Base Unit Quality: 0
Code Added: 01-01-2005
Action Effective Date: 01-01-2005
Action Code: N (No maintenance for this code)