B4155 HCPCS - 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

Code Information

HCPCS Code: B4155
Sequence Number: 0010
Short Description: Ef incomplete/modular
Long Description: 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
Date Added: 1/1/1986
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:
- 39 - Parenteral and Enteral Nutrition
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:
- 2130
- 4450
Coverage Code: D - Special coverage instructions apply

Field Name	Field Value
Healthcare Common Procedure Coding System Code	B4155
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 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
HCPCS Short Description	Ef incomplete/modular
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	1/1/1986
HCPCS Action Effective Date	1/1/2005
HCPCS Action Code	N - No maintenance for this code