Field Name |
Field Value |
Healthcare Common Procedure Coding System Code |
B4159 |
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, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
HCPCS Short Description |
Ef ped complete soy based |
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 |