B4104 – Additive for enteral formula (e.g., fiber)

Long description

Additive for enteral formula (e.g., fiber)

Short description

Additive for enteral formula

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

D Special coverage instructions apply

BETOS category

O1C Enteral and parenteral

Added

January 1, 2005

Last change

January 1, 2005 – No change

Nearby B codes

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• B4082 – Nasogastric tubing without stylet
• B4083 – Stomach tube - levine type
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• B4088 – Gastrostomy/jejunostomy tube, low-profile, any material, any type, each
• B4100 – Food thickener, administered orally, per ounce
• B4102 – Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
• B4103 – Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
• B4105 – In-line cartridge containing digestive enzyme(s) for enteral feeding, each
• B4148 – Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
• B4149 – Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4150 – Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4152 – Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4153 – 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
• B4154 – Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4155 – Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit