HCPCS Code B4149

Official Description

Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Short Descr	Ef blenderized foods
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
MCM	2130
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	Not applicable/unspecified.
IOM	100-02, 15, 120
OTS Orthotic	No
CCS Clinical Classification	223 - Enteral and parenteral nutrition

KX	Requirements specified in the medical policy have been met
GA	Waiver of liability statement issued as required by payer policy, individual case
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
GZ	Item or service expected to be denied as not reasonable and necessary
BO	Orally administered nutrition, not by feeding tube
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GL	Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
KT	Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
CR	Catastrophe/disaster related
EY	No physician or other licensed health care provider order for this item or service
U1	Medicaid level of care 1, as defined by each state
GX	Notice of liability issued, voluntary under payer policy
GW	Service not related to the hospice patient's terminal condition