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BETA v.3.0

2025 HCPCS code B4154

Nutritionally complete enteral formula for specific metabolic needs (excluding inherited metabolic disorders), with modified protein, fat, carbohydrate, vitamin, and/or mineral composition, possibly including fiber, administered via feeding tube (100 calories = 1 unit).

This code is reported in units of 100 calories. If two products under this code are administered concurrently, they should be billed on a single line with the combined units of service.

Modifiers may be applicable to this code depending on specific circumstances. Refer to HCPCS modifier guidelines for appropriate usage.

Medical necessity for this code requires documentation demonstrating that the patient's metabolic condition necessitates the use of a specialized formula and why a standard enteral formula is not appropriate.

Physicians or other licensed healthcare providers are responsible for prescribing and managing the use of this specialized enteral formula. Registered dietitians may also be involved in assessing the patient’s nutritional needs and recommending appropriate formulas.

In simple words: This is a special feeding formula given through a feeding tube to people who can't eat normally and have specific metabolic needs, but not for those with genetic metabolic diseases. It has the right balance of nutrients but adjusted for their condition. It's measured in units of 100 calories.

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit.

Example 1: A patient with Crohn's disease experiencing malabsorption requires a specialized enteral formula to meet their nutritional needs and promote healing., A patient with short bowel syndrome needs a formula with modified fat and carbohydrate ratios to optimize absorption., A patient recovering from major surgery and unable to eat normally requires an enteral formula to support their recovery.

Documentation must support the medical necessity of the special formula, specifying why a standard formula isn't suitable. This should include details about the patient's metabolic needs, any failed trials of other formulas, and relevant diagnoses.

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