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BETA v.3.0

2025 HCPCS code B4187

Omegaven, 10 grams lipids.

Bill one unit per 10 grams of Omegaven administered. When used with an IV pole (E0776), append modifier BA to E0776. Verify coverage with individual payers, as policies may vary.

Modifier JW may be applicable if a partial dose is discarded.

Medical necessity for Omegaven is established by a diagnosis of PNAC in pediatric patients requiring parenteral nutrition.Documentation should demonstrate impaired liver function and the need for a specialized lipid emulsion to prevent further complications and support growth and development.

Administered by healthcare professionals, often in a hospital setting, under the supervision of a physician or registered dietitian.

IMPORTANT:For 10g of lipids not otherwise specified, use B4185. Other parenteral solutions and supplies are found in the B4164-B5200 range. For the 5g/50mL dose, bill 0.5 units.

In simple words: Omegaven is a special type of fat (lipid) given through a vein (IV) to children who have liver problems related to receiving nutrition through an IV.It helps them get the calories and healthy fats they need when they can't eat normally.It's made from fish oil and comes in small bottles.

Omegaven (fish oil triglycerides) is an injectable lipid emulsion specifically designed for pediatric patients with Parenteral Nutrition-Associated Cholestasis (PNAC). This fish oil-based solution delivers essential calories and fatty acids intravenously. The dosage varies depending on individual patient factors such as age, weight, clinical status, and metabolic capacity, but typically doesn't exceed 1 g/kg/day. The emulsion is provided in single-dose bottles of 5g/50 mL and 10g/100 mL (0.1 g/mL). Code B4187 is reported for every 10 grams of lipids administered as Omegaven.Omegaven is administered to provide calories and fatty acids to pediatric patients with PNAC. It's available in 5 g/50 mL and 10 g/100 mL single-dose bottles.

Example 1: A 3-year-old child with short bowel syndrome develops PNAC. Omegaven is prescribed to provide essential fatty acids and calories while minimizing further liver damage., A premature infant with intestinal failure requires long-term PN and develops cholestasis.Omegaven is used as part of their PN regimen to improve liver function and support growth., A 10-year-old child with Crohn's disease and severe malnutrition is receiving PN. They develop PNAC, and Omegaven is introduced to their treatment plan.

Diagnosis of PNAC, patient age, weight, dose administered, clinical rationale for using Omegaven, relevant lab results (e.g., liver function tests), and any adverse reactions.

** This information is current as of December 1st, 2024.Always verify coding and coverage guidelines with the relevant payers. For specific questions, consult iFrameAI.This information is intended for informational purposes only and does not constitute medical advice.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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