Field Name |
Field Value |
Healthcare Common Procedure Coding System Code |
B4104 |
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 |
Additive for enteral formula (e.g., fiber) |
HCPCS Short Description |
Additive for enteral formula |
HCPCS Pricing Indicator Code 1 |
00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.) |
HCPCS Multiple Pricing Indicator Code |
9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99') |
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 |