B4162 HCPCS - 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

Code Information

HCPCS Code: B4162
Sequence Number: 0010
Short Description: Ef ped specmetabolic inherit
Long Description: 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
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	B4162
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, 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
HCPCS Short Description	Ef ped specmetabolic inherit
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