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2025 HCPCS code B4155

Use of a nutritionally incomplete enteral formula (modular nutrients) in 100-calorie units, administered via feeding tube.

Refer to HCPCS coding guidelines for enteral and parenteral nutrition, including the requirements for documentation of medical necessity and the selection of appropriate codes based on the specific nutrients provided. Payer-specific requirements may also apply. Prior authorization might be necessary.

Modifiers may be applicable depending on circumstances, such as the place of service or the type of feeding tube used. Consult modifier guidelines and payer requirements.

Enteral nutrition is medically necessary when a patient is unable to consume sufficient nutrients orally to meet their nutritional needs.This may be due to conditions like stroke, trauma, critical illness, or gastrointestinal disorders. Medical necessity must be documented to support the use of B4155 and ensure proper reimbursement.

The physician or other qualified healthcare professional is responsible for ordering and monitoring the enteral nutrition therapy.A registered dietitian may assist in the nutritional assessment and formulation of the enteral feeding plan.

IMPORTANT:Codes B4149-B4162 represent other enteral formulas with varying nutrient supplements.Consider using these if the patient's nutritional needs don't align with B4155.

In simple words: This code covers giving a special type of liquid food through a tube into the stomach or intestines.The liquid food is customized to meet a patient's needs if they can't eat enough regularly because of illness or problems with their digestive system.The doctor must show why this special food is needed.

This HCPCS code reports the administration of a nutritionally incomplete enteral formula, supplied in 100-calorie units.The formula consists of specific modular nutrients (carbohydrates, fats, proteins, etc.) individually or in combination, tailored to meet a patient's unique nutritional needs.It's administered through an enteral feeding tube into the stomach or small intestine for patients unable to maintain adequate oral intake due to illness or gastrointestinal disorders.Medicare coverage requires medical necessity documentation.

Example 1: A patient recovering from a stroke has difficulty swallowing and needs supplemental nutrition.B4155 is used to document the administration of a custom-blended enteral formula delivered via a nasogastric tube., A patient with severe Crohn's disease experiences malabsorption and requires specialized enteral nutrition support.B4155 is used to document the provision of a modular nutrient formula via a jejunostomy tube., A critically ill patient in the ICU is unable to consume adequate nutrition orally and requires parenteral and enteral nutrition support. B4155 is used for the enteral component of the nutrition plan, while other codes would reflect parenteral nutrition if utilized.

* Physician's order specifying the type and amount of the formula.* Documentation of the patient's nutritional needs and assessment (e.g., height, weight, laboratory values).* Evidence of medical necessity demonstrating why enteral nutrition is required (e.g., difficulty swallowing, malabsorption).* Detailed record of the formula's composition (specific modular nutrients used and their quantities).* Documentation of the route of administration (e.g., nasogastric tube, gastrostomy tube).* Regular monitoring of the patient's tolerance and response to the enteral nutrition.

** Always check payer-specific requirements for coverage and coding rules related to enteral nutrition.

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

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