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B4158 - Ef ped complete intact nut

Navigation: HCPCS Codes > Codes with Prefix: B4
Field Value
HCPCS Code: B4158
Long Description: Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit
Short Description: Ef ped complete intact nut
Pricing Indicator 1: 46 (Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts))
Multiple Pricing Code: A (Not applicable as HCPCS priced under one methodology)
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)