HCPCS Codes for Abbott Nutrition Enteral Formulas The

HCPCS Codes for Abbott Nutrition Enteral Formulas The Healthcare Common Procedure Coding System codes are utilized by Medicare for billing purposes. They are also used by many Medicaid and Commercial plans for billing purposes. B 4102 Adult hydration formulas Ensure® Clear Ensure® Pre-Surgery B 4103 Pediatric hydration formulas Ensure® Clear Pedialyte Advanced. Care® B 4149 Blenderized formulas Pedia. Sure Harvest. TM B 4150 Ensure® General purpose formulas Original Compact Ensure® High Protein Ensure® Powder B 4152 Calorically dense formulas Ensure® Enlive® Ensure® Plus Hi-Cal Jevity® 1. 5 Cal Jevity® 1. 0 Cal Jevity® 1. 2 Cal Osmolite® 1. 5 Cal B 4153 Hydrolyzed protein elemental formulas Perative® Pivot® 1. 5 Cal Vital® 1. 0 Cal Vital® AF 1. 2 Cal B 4154 Formulas for special metabolic needs Glucerna® 1. 0 Cal Glucerna® 1. 2 Cal Glucerna® 1. 5 Cal Glucerna® Shake Glucerna Hunger Smart® Shake Nepro® with CARBSTEADY® B 4155 Modular nutrients Juven® Pro-Phree® Pro. Vi. Min® Osmolite® 1. 2 Cal Promote® With Fiber Two. Cal® HN Vital® 1. 5 Cal Vital® High Protein Oxepa® Pulmocare® Similac® PM 60/40 Suplena® with CARBSTEADY® RCF® Pro. Mod® Liquid Protein Similac® Human Milk Fortifier NOTE: Each healthcare provider is ultimately responsible for verifying codes, coverage, and payment policies used to ensure that they are accurate for the services and items provided. Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance plans.

HCPCS Codes for Abbott Nutrition Enteral Formulas B 4157 Formulas for special metabolic needs of inherited disease of metabolism Cyclinex®-2 Glutarex®-2 Hominex®-2 I-Valex®-2 Ketonex®-2 B 4158 Pediatric general purpose formulas Similac® Advance® Similac Sensitive® Similac Pro-Sensitive® Similac for Spit-Up® Similac® Organic Similac Pro-Advance® B 4159 Pediatric soy-based formulas Similac® Soy Isomil® Similac® for Diarrhea B 4160 Pediatric calorically dense formulas Pedia. Sure® 1. 5 Cal Pedia. Sure® with Fiber Pedia. Sure® 1. 5 Cal with Fiber Pedia. Sure® Enteral Formula 1. 0 Cal with Fiber Phenex®-2 Vanilla Similac Go & Grow® Similac® Total Comfort Pediatric enteral formulas with hydrolyzed/amino acids and peptide chain proteins Ele. Care® DHA/ARA Ele. Care® Jr Unflavored Ele. Care® Jr Vanilla Ele. Care® Jr Chocolate Ele. Care® Jr Banana Pedia. Sure® Peptide 1. 0 Cal Pediatric formulas for special metabolic needs of inherited disease of metabolism Calcilo XD® Cyclinex®-1 Glutarex®-1 Hominex®-1 I-Valex®-1 Ketonex®-1 Pedia. Sure Side. Kicks®. 63 Cal Similac® for Supplementation Similac Go & Grow® Soy-Based Formula B 4161 B 4162 Propimex®-2 Tyrex®-2 Similac Neo. Sure® Similac® Special Care® 24 with Iron Similac® Special Care® 30 with Iron Pedia. Sure® Peptide 1. 5 Cal Similac Alimentum® Vital® Peptide Phenex™-1 Propimex®-1 Tyrex® -1 The following products may be used by children (using code B 4162) or adults (using code B 4157) Cyclinex®-2 Glutarex®-2 Hominex®-2 I-Valex®-2 Ketonex®-2 Phenex®-2 Vanilla Propimex®-2 Tyrex®-2 NOTE: Each healthcare provider is ultimately responsible for verifying codes, coverage, and payment policies used to ensure that they are accurate for the services and items provided. Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance plans. ® 2019 Abbott Laboratories Inc. 181708/March 2019 LITHO IN USA Abbott Nutrition Abbott Laboratories Columbus, Ohio 43219 -3034 USA