| B4034 |
Enter feed supkit syr by day |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| B4035 |
Enteral feed supp pump per d |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| B4036 |
Enteral feed sup kit grav by |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| B4081 |
Enteral ng tubing w/ stylet |
Nasogastric tubing with stylet |
| B4082 |
Enteral ng tubing w/o stylet |
Nasogastric tubing without stylet |
| B4083 |
Enteral stomach tube levine |
Stomach tube - levine type |
| B4087 |
Gastro/jejuno tube, std |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
| B4088 |
Gastro/jejuno tube, low-pro |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
| B4100 |
Food thickener oral |
Food thickener, administered orally, per ounce |
| B4102 |
Ef adult fluids and electro |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
| B4103 |
Ef ped fluid and electrolyte |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
| B4104 |
Additive for enteral formula |
Additive for enteral formula (e.g., fiber) |
| B4105 |
Enzyme cartridge enteral nut |
In-line cartridge containing digestive enzyme(s) for enteral feeding, each |
| B4148 |
Enteral feed elastomer daily |
Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
| B4149 |
Ef blenderized foods |
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 |
Ef complet w/intact nutrient |
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 |
Ef calorie dense>/=1.5kcal |
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 |
Ef hydrolyzed/amino acids |
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 |
Ef spec metabolic noninherit |
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 |
Ef incomplete/modular |
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 |
| B4157 |
Ef special metabolic inherit |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4158 |
Ef ped complete intact nut |
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 |
| B4159 |
Ef ped complete soy based |
Enteral formula, for pediatrics, nutritionally complete soy based 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 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
| B4161 |
Ef ped hydrolyzed/amino acid |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4162 |
Ef ped specmetabolic inherit |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4164 |
Parenteral 50% dextrose solu |
Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix |
| B4168 |
Parenteral sol amino acid 3. |
Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix |
| B4172 |
Parenteral sol amino acid 5. |
Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix |
| B4176 |
Parenteral sol amino acid 7- |
Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix |
| B4178 |
Parenteral sol amino acid > |
Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix |
| B4180 |
Parenteral sol carb > 50% |
Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix |
| B4185 |
Pn soln nos 10 grams lipids |
Parenteral nutrition solution, not otherwise specified, 10 grams lipids |
| B4187 |
Omegaven, 10 grams lipids |
Omegaven, 10 grams lipids |
| B4189 |
Parenteral sol amino acid & |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix |
| B4193 |
Parenteral sol 52-73 gm prot |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix |
| B4197 |
Parenteral sol 74-100 gm pro |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix |
| B4199 |
Parenteral sol > 100gm prote |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix |
| B4216 |
Parenteral nutrition additiv |
Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day |
| B4220 |
Parenteral supply kit premix |
Parenteral nutrition supply kit; premix, per day |
| B4222 |
Parenteral supply kit homemi |
Parenteral nutrition supply kit; home mix, per day |
| B4224 |
Parenteral administration ki |
Parenteral nutrition administration kit, per day |
| B5000 |
Parenteral sol renal-amirosy |
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix |
| B5100 |
Parenteral solution hepatic |
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic, hepatamine-premix |
| B5200 |
Parenteral sol hepatic fream |
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids-freamine-hbc-premix |
| B9000 |
Enter infusion pump w/o alrm |
Enteral nutrition infusion pump - without alarm |
| B9002 |
Enter nutr inf pump any type |
Enteral nutrition infusion pump, any type |
| B9004 |
Parenteral infus pump portab |
Parenteral nutrition infusion pump, portable |
| B9006 |
Parenteral infus pump statio |
Parenteral nutrition infusion pump, stationary |
| B9998 |
Enteral supp not otherwise c |
Noc for enteral supplies |
| B9999 |
Parenteral supp not othrws c |
Noc for parenteral supplies |
| BA |
Item w pen services |
Item furnished in conjunction with parenteral enteral nutrition (pen) services |
| BL |
Spec acquisition blood prods |
Special acquisition of blood and blood products |
| BO |
Nutrition oral admin no tube |
Orally administered nutrition, not by feeding tube |
| BP |
Bene electd to purchase item |
The beneficiary has been informed of the purchase and rental options and has elected to purchase the item |
| BR |
Bene elected to rent item |
The beneficiary has been informed of the purchase and rental options and has elected to rent the item |
| BU |
Bene undecided on purch/rent |
The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision |
