| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
B4154 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
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 |
| HCPCS Short Description |
Ef spec metabolic noninherit |
| HCPCS Pricing Indicator Code 1 |
39 - Parenteral and Enteral Nutrition |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Coverage Issues Manual Reference Section Number 1 |
65-10 |
| HCPCS Medicare Carriers Manual Reference Section Number 1 |
2130 |
| HCPCS Medicare Carriers Manual Reference Section Number 2 |
4450 |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Berenson-Eggers Type Of Service Code |
O1C - Enteral and parenteral |
| HCPCS Type Of Service Code 1 |
E - Enteral/parenteral nutrients/supplies (eff 04/95) |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/1984 |
| HCPCS Action Effective Date |
1/1/2005 |
| HCPCS Action Code |
N - No maintenance for this code |