2025 HCPCS code B4153
(Active) Effective Date: N/A Revision Date: N/A Supplies - Enteral Formulas and Additives Enteral and Parenteral Therapy Feed
Supply of a nutritionally complete enteral formula (100 calories) with hydrolyzed proteins, fats, carbohydrates, vitamins, minerals, and fiber (if needed).
Modifiers may apply depending on the specific circumstances of service. Refer to the specific payer's guidelines for modifier usage.
Medical necessity for B4153 is established by documenting the patient's inability to consume adequate nutrition orally due to a medical condition. This requires a thorough assessment of the patient's nutritional status, including weight loss, laboratory values, and clinical presentation. The choice of formula should be justified based on the patient's specific needs and tolerance.
The clinical responsibility lies with the physician or other qualified healthcare provider who orders and monitors the patient's enteral nutrition therapy. This includes assessing the patient's nutritional needs, selecting the appropriate formula, monitoring tolerance and efficacy, and adjusting the plan as needed. Registered dietitians often play a crucial role in this process.
In simple words: This code covers the cost of a special liquid food formula given through a tube into the stomach or intestines. The formula is complete nutrition, meaning it has all the nutrients a person needs.It's for people who can't eat enough regular food.
This HCPCS code, B4153, represents the supply of a nutritionally complete enteral formula containing hydrolyzed or predigested proteins, along with fats, carbohydrates, vitamins, minerals, and fiber (as needed), provided in units of 100 calories.A nutritionally complete formula provides sufficient protein, fats, carbohydrates, vitamins, and minerals to serve as the patient's sole nutritional source.Administration is via a feeding tube into the stomach or small intestine.Medicare coverage requires documentation of medical necessity.
Example 1: A 70-year-old patient with dysphagia (difficulty swallowing) following a stroke requires long-term enteral nutrition.B4153 would be used to bill for the supply of the hydrolyzed protein formula., A 55-year-old patient with Crohn's disease experiencing severe malabsorption needs supplemental nutrition.B4153 would be used to bill for the provision of a nutritionally complete formula delivered via a jejunostomy tube., A 30-year-old patient recovering from extensive facial trauma requires enteral nutrition due to inability to ingest food orally. B4153 is used for the supply of the prescribed formula.
* Physician's order specifying the type and quantity of formula.* Documentation of the patient's nutritional needs and medical necessity for enteral nutrition.* Evidence of the patient's inability to consume adequate nutrition orally.* Progress notes reflecting the patient's response to the enteral nutrition.* Documentation of the administration method (e.g., nasogastric tube, gastrostomy tube, jejunostomy tube).
** The specific composition of the formula covered by B4153 may vary.Always refer to the product labeling and ensure appropriate documentation of the formula administered to support medical necessity.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gastroenterology, Surgery, Oncology, Critical Care, Registered Dietitian
- Place of Service:Inpatient Hospital, Outpatient Hospital, Skilled Nursing Facility, Home Health Agency