2025 HCPCS code B4158
(Active) Effective Date: N/A Revision Date: N/A Enteral and Parenteral Therapy - Enteral Formulas and Additives B4100-B4162 B4034-B9999 Feed
Nutritionally complete enteral formula with intact nutrients for pediatric patients, administered through a feeding tube (100 calories = 1 unit).
Modifiers may be applicable depending on the specific circumstances of the case.
Medical necessity must be established by demonstrating the patient's inability to obtain sufficient nutrition through oral intake. Conditions like prematurity, swallowing disorders, malabsorption, or specific metabolic needs can justify the use of enteral nutrition.
The provider is responsible for ensuring the medical necessity of the formula, documenting its use, and administering it correctly via a feeding tube to the pediatric patient.
In simple words: This code covers a complete feeding formula given through a feeding tube to children who can't eat enough by mouth. The formula has all the necessary nutrients and is given in units of 100 calories.
This code represents a nutritionally complete enteral formula containing intact nutrients (proteins, fats, carbohydrates, vitamins, and minerals), possibly including fiber and/or iron, administered through an enteral feeding tube to pediatric patients who cannot obtain adequate nutrition orally.The formula is designed to be a sole source of nutrition and is measured in units of 100 calories.
Example 1: A premature infant with underdeveloped digestive system requires enteral feeding with B4158 to support growth and development., A child with a swallowing disorder following surgery receives B4158 to maintain adequate nutrition during recovery., A child with cystic fibrosis needs B4158 due to malabsorption issues and inability to consume enough calories orally.
Documentation should include the medical necessity for enteral feeding, type of formula (B4158), amount administered (in units of 100 calories), method of administration (feeding tube), and patient tolerance.
- Payment Status: Active
- Specialties:Pediatrics, Gastroenterology, Dietetics
- Place of Service:Inpatient Hospital, Outpatient Hospital, Home, Skilled Nursing Facility, Nursing Facility