2025 HCPCS code B4152
(Retired) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Nutritional Products - Enteral Formulas and Additives Enteral and Parenteral Therapy Feed
Supply of a nutritionally complete, calorically dense enteral formula (≥1.5 kcal/mL) with intact nutrients, administered via feeding tube; 100 calories = 1 unit.
Modifiers may apply depending on the circumstances of service, such as the place of service or the type of provider. Refer to official HCPCS guidelines for details.
Medical necessity for B4152 is established when a patient is unable to consume adequate nutrition orally due to a medical condition and requires enteral nutrition for the maintenance of health or recovery.Documentation must support the diagnosis, inability to consume sufficient nutrients orally, and the benefits of enteral nutrition compared to other options.Payers may have specific criteria for coverage.
The clinical responsibility for this code lies with the physician or other qualified healthcare provider who orders and monitors the enteral nutrition therapy.This includes assessing the patient's nutritional needs, selecting the appropriate formula, and monitoring the patient's response to the therapy.
In simple words: This code is for a special type of liquid food given through a tube into the stomach. It's nutritionally complete, meaning it has all the vitamins and nutrients a person needs, and it's high in calories.The amount billed is based on how many calories are provided.
This HCPCS code, B4152, covers the provision of a nutritionally complete, calorically dense enteral formula containing intact proteins, fats, carbohydrates, vitamins, minerals, and potentially fiber.The formula must have a caloric density of at least 1.5 kcal/mL. Administration is via an enteral feeding tube into the stomach or small intestine.The code is reported in units of 100 calories.
Example 1: A patient recovering from a stroke is unable to swallow and needs nutritional support.B4152 would be used to bill for the provision of a nutritionally complete, high-calorie enteral formula administered via a nasogastric tube., A patient with severe Crohn's disease experiences malabsorption and requires long-term enteral nutrition.B4152 would be billed for the formula used, documented with clinical notes supporting medical necessity., A patient post-surgery with significant bowel obstruction cannot tolerate oral intake. The physician orders a nutritionally complete formula (B4152) to be administered through a jejunostomy tube.Detailed documentation of the patient's condition, tube placement, and formula administration is essential.
* Physician's order for enteral nutrition specifying the formula (B4152)* Documentation of the patient's inability to maintain adequate oral intake* Assessment of the patient's nutritional status* Monitoring of the patient's response to the enteral nutrition* Records of formula administration (volume and frequency)* Progress notes indicating medical necessity
** This code is retired and should not be used for current billing.Alternative current codes should be used. Refer to the most up-to-date HCPCS code set and payer guidelines for appropriate coding.
- Payment Status: Inactive
- Specialties:Gastroenterology, Surgery, Oncology, Critical Care, Geriatrics, Nutritional Support
- Place of Service:Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility, Home Healthcare