| 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) |
