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Official Description

Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
Short Descr Ef adult fluids and electro
Coverage Special coverage instructions apply
Pricing Indicator(s) 39 – Supplies And Surgical Dressings - Parenteral and Enteral Nutrition
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 65-10
BETOS O1C – Enteral and parenteral
TOS Code(s) E – Enteral/parenteral nutrients/supplies
Added Date 1/1/2005
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 0
IOM 100-03, 3, 180.2
OTS Orthotic No
CCS Clinical Classification 223 - Enteral and parenteral nutrition
BO Orally administered nutrition, not by feeding tube
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GA Waiver of liability statement issued as required by payer policy, individual case
KX Requirements specified in the medical policy have been met
GZ Item or service expected to be denied as not reasonable and necessary
PO Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
Date
Action
Notes
2005-01-01 Added Code added 1/1/2005
Code
Description
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