| HCPCS Code: |
B4153 |
| Long Description: |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| Short Description: |
Ef hydrolyzed/amino acids |
| Pricing Indicator 1: |
39 (Parenteral and Enteral Nutrition) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| Coverage Issues Manual 1: |
65-10 |
| MCM Reference Section Number 1: |
2130 |
| MCM Reference Section Number 2: |
4450 |
| 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: |
01-01-1986 |
| Action Effective Date: |
01-01-2005 |
| Action Code: |
N (No maintenance for this code) |
