2025 HCPCS code B4104
(Active) Effective Date: N/A Revision Date: N/A Nutritional Products - Enteral Formula Additives Enteral Formulas and Additives Feed
Additive for enteral formula (e.g., fiber).
Modifiers may be applicable depending on the circumstances of service.
The medical necessity of code B4104 is based on the patient's clinical condition requiring enteral nutrition and the specific need for the additive to address a documented complication or improve nutritional status.Documentation must clearly link the additive to the patient's clinical needs.
Physician or other qualified healthcare provider responsible for ordering and monitoring enteral nutrition therapy.
In simple words: This code covers extra ingredients added to liquid food given through a feeding tube, like fiber to help with constipation.It's only used when adding something to an existing formula.
HCPCS code B4104 represents an additive for enteral formulas, such as fiber, used to supplement tube feeding.This code is used when an additive is added to an existing enteral formula to address specific nutritional needs or to manage complications, such as constipation. The additive is administered through a feeding tube into the stomach or small intestine.
Example 1: A patient with dysphagia (difficulty swallowing) requires enteral nutrition.They experience constipation, so fiber is added to their enteral formula. Code B4104 would be reported for the fiber additive., A patient with a short bowel syndrome receives a standard enteral formula.To increase caloric density, a concentrated carbohydrate additive is added. Code B4104 would be used if this additive is separately billed., A patient receiving continuous enteral nutrition experiences recurrent diarrhea.To improve stool consistency, a fiber-based additive is prescribed and administered.Code B4104 would be utilized for the fiber additive.
* Patient's diagnosis necessitating enteral nutrition.* Type and amount of enteral formula used.* Type and amount of additive administered (B4104).* Physician's order specifying the additive.* Medical necessity documentation supporting the use of the additive.* Documentation supporting the need for enteral feeding.
** The use of code B4104 requires careful consideration of the included ingredients in the main enteral formula.If the additive is already included, separate billing might be inappropriate and lead to claim denials. Consult payer specific guidelines for complete accuracy.
- Payment Status: Active
- Specialties:Gastroenterology, Nutritional Support, Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility, Home Healthcare