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BETA v.3.0

2025 HCPCS code B4189

Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix.

When premix solutions are used, there should be no separate billing for carbohydrates, amino acids, or additives. Lipids (B4185 or B4187) are separately billable with premix solutions. One unit of service represents one day's supply of protein and carbohydrate.

Modifier BA is used when an IV pole (E0776) is used in conjunction with parenteral nutrition.

Medical necessity must be established for the use of parenteral nutrition. This includes documentation of the patient's inability to obtain adequate nutrition through oral or enteral routes.

A parenteral nutrition solution supplies nutrients intravenously for a patient whose digestive tract does not function properly. The composition of nutrients in the solution depends upon the composition of nutrients and their sources in each product.

In simple words: This code represents a pre-mixed nutritional solution given through an IV to patients who can't digest food normally. It contains essential nutrients like proteins, carbohydrates, vitamins, and minerals.

This code covers a premix parenteral nutrition solution of any strength containing 10 to 51 grams of protein and composed of compounded amino acids and carbohydrates, electrolytes, trace elements, and vitamins.It is used for patients whose digestive tract does not function properly. The parenteral solution can be given either through a central vein or a peripheral vein.

Example 1: A patient with Crohn's disease experiencing a severe flare-up is unable to absorb nutrients through their digestive system. B4189 is used to provide necessary nutrition intravenously., A patient undergoing chemotherapy experiences severe nausea and vomiting, preventing them from eating. B4189 is used to maintain their nutritional status during treatment., A patient with short bowel syndrome requires long-term parenteral nutrition. B4189 is used to provide a balanced mix of nutrients.

Documentation should include medical necessity for parenteral nutrition, patient's weight and nutritional needs, type and amount of solution administered, and route of administration.

** For the same parenteral nutrition solution with different amounts of protein, see B4193 to B4199. Medicare covers parenteral nutrition formulas as long as the provider documents it as medically necessary.

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

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