B4103 HCPCS - ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G., CLEAR LIQUIDS), 500 ML = 1 UNIT

Code Information

HCPCS Code: B4103
Sequence Number: 0010
Short Description: Ef ped fluid and electrolyte
Long Description: Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
Date Added: 1/1/2005
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2005
Classification: Enteral and Parenteral Therapy
Coding System: HCPCS

Pricing Indicator Code:
- 46 - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
- 65-10
Medicare Carriers Manual Reference Section Number:
N/A
Coverage Code: D - Special coverage instructions apply

Field Name	Field Value
Healthcare Common Procedure Coding System Code	B4103
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, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
HCPCS Short Description	Ef ped fluid and electrolyte
HCPCS Pricing Indicator Code 1	46 - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
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 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	1/1/2005
HCPCS Action Effective Date	1/1/2005
HCPCS Action Code	N - No maintenance for this code