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Enteral Supplies Allowable Amounts
Better Living Now has developed preferred product relationships with industry leading manufacturers in an effort to bring you the highest quality products available that will be 100% covered by your insurance/Medicare plan with no additional out-of-pocket expense to you.
Contact us for more informationEnteral Supplies Allowable Amounts - Effective 08/02/2011
B4034
ENTERAL FEEDING SUPPLY KIT; SYRINGE FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE
B4035 ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED
TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE
B4036 ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY, INCLUDES BUT NOT
LIMITED TO FEEDING/FLUSHING SYRINGE, ADMINISTRATION SET TUBING, DRESSINGS, TAPE
B4081 NASOGASTRIC TUBING WITH STYLET
B4082 NASOGASTRIC TUBING WITHOUT STYLET
B4083 STOMACH TUBE - LEVINE TYPE
B4087 GASTROSTOMY/JEJUNOSTOMY TUBE, STANDARD, ANY MATERIAL, ANY TYPE, EACH
B4088
GASTROSTOMY/JEJUNOSTOMY TUBE, LOW-PROFILE, ANY MATERIAL, ANY TYPE, EACH
B4100 FOOD THICKENER, ADMINISTERED ORALLY, PER OUNCE
B4102
ENTERAL FORMULA, FOR ADULTS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G. CLEAR LIQUIDS), 500 ML = 1 UNIT
B4103
ENTERAL FORMULA, FOR PEDIATRICS, USED TO REPLACE FLUIDS AND ELECTROLYTES (E.G. CLEAR LIQUIDS), 500 ML = 1 UNIT
B4149
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
B4150
ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4152
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, CALORICALLY DENSE (EQUAL TO OR GREATER THAN 1.5 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4153
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, HYDROLYZED PROTEINS (AMINO ACIDS AND PEPTIDE CHAIN), INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4154
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR SPECIAL METABOLIC NEEDS, EXCLUDES INHERITED DISEASE OF METABOLISM, INCLUDES ALTERED COMPOSITION OF PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND/OR MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4155
ENTERAL FORMULA, NUTRITIONALLY INCOMPLETE/MODULAR NUTRIENTS, INCLUDES SPECIFIC NUTRIENTS, CARBOHYDRATES (E.G. GLUCOSE POLYMERS), PROTEINS/AMINO ACIDS (E.G. GLUTAMINE, ARGININE), FAT (E.G. MEDIUM CHAIN TRIGLYCERIDES) OR COMBINATION, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4157
ENTERAL FORMULA, NUTRITIONALLY COMPLETE, FOR 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
B4158
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE 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
B4159
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
B4160
ENTERAL FORMULA, FOR PEDIATRICS, NUTRITIONALLY COMPLETE CALORICALLY DENSE (EQUAL TO OR GREATER THAN 0.7 KCAL/ML) WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4161
ENTERAL FORMULA, FOR PEDIATRICS, HYDROLYZED/AMINO ACIDS AND PEPTIDE CHAIN PROTEINS, INCLUDES FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4162
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
B9000 ENTERAL NUTRITION INFUSION PUMP - WITHOUT ALARM
B9002 ENTERAL NUTRITION INFUSION PUMP - WITH ALARM
B9998 NOC FOR ENTERAL SUPPLIES
E0776 IV POLE
Notes - none
Enteral Supplies Guidelines
General InformationFor more information on local coverage determination Local Coverage Determination (LCD) for Enteral SuppliesDocumentations Requirements
Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there
has been furnished such information as may be necessary in order to determine the amounts due such
provider." It is expected that the patient's medical records will reflect the need for the care provided. The
patient's medical records include the physician's office records, hospital records, nursing home records,
home health agency records, records from other healthcare professionals and test reports. This
documentation must be available upon request.
A detailed written order for each item billed must be signed and dated by the treating physician, kept on
file by the supplier, and made available upon request. Items billed before a signed and dated detailed
written order has been received by the supplier must be submitted with an EY modifier added to each
affected HCPCS code.
A DME Information Form (DIF), which has been completed, signed, and dated by the supplier, must be
kept on file by the supplier and made available upon request. The DIF for Enteral Nutrition is CMS Form
10126. The initial claim must include an electronic copy of the DIF.
A new Initial DIF for enteral nutrients is required when
1. A formula billed with a different code, which has not been previously certified, is ordered, or
2. Enteral nutrition services are resumed after they have not been required for two consecutive
months.
A new Initial DIF for a pump (B9000 or B9002) is required when
1. Enteral nutrition services involving use of a pump are resumed after they have not been required
for two consecutive months, or
2. A patient receiving enteral nutrition by the syringe or gravity method is changed to administration
using a pump.
A revised DIF for enteral nutrients is required when:
1. The number of calories per day is changed, or
2. The number of days per week administered is changed, or
3. The method of administration (syringe, gravity, pump) changes, or
4. The route of administration is changed from tube feedings to oral feedings (if billing for denial).
Special nutrient formulas, HCPCS codes B4149, B4153-B4157, B4161, and B4162, are produced to meet
unique nutrient needs for specific disease conditions. The patient's medical record must adequately
document the specific condition and the need for the special nutrient. This information shall be
available upon request.
If two enteral nutrition products, which are described by the same HCPCS code, are being provided at
the same time, they should be billed on a single claim line with the units of service reflecting the total
calories of both nutrients.
Refills
A routine refill prescription is not needed. A new prescription is needed when:
• There is a change of supplier
• There is a change in treating physician
• There is a change in the item(s), frequency of use, or amount prescribed
• There is a change in the length of need or a previously established length of need expires
• State law requires a refill renewal
For items that the patient obtains in person at a retail store, the signed delivery slip or copy of itemized
sales receipt is sufficient documentation of a request for refill.
For items that are delivered to the beneficiary, documentation of a request for refill must be either a
written document received from the beneficiary or a contemporaneous written record of a phone
conversation/contact between the supplier and beneficiary. The refill request must occur and be
documented before shipment. A retrospective attestation statement by the supplier or beneficiary is not
sufficient. The refill record must include:
• Beneficiary's name or authorized representative if different than the beneficiary
• A description of each item that is being requested
• Date of refill request
• Quantity of each item that the beneficiary still has remaining
This information must be kept on file and be available upon request.
Refer to the Supplier Manual for more information on documentation requirements.
For more information on local coverage determination Local Coverage Determination (LCD) for Enteral Supplies
