2025 HCPCS code B4161
(Active) Effective Date: N/A Revision Date: N/A Nutritional Products - Enteral Formulas and Additives Enteral and Parenteral Therapy Feed
Enteral formula for pediatrics; hydrolyzed/amino acids and peptide chain proteins; includes fats, carbohydrates, vitamins, and minerals; may include fiber; administered through an enteral feeding tube; 100 calories = 1 unit.
Modifiers may be applicable depending on the circumstances of service. Consult the specific payer's guidelines for appropriate modifier usage.
Medical necessity for B4161 is established when the patient is unable to meet their nutritional needs through oral intake due to a medical condition.Documentation supporting medical necessity should clearly demonstrate the inability to consume adequate nutrition orally and the benefits of using this specialized pediatric formula.
The clinical responsibility for this code rests 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, monitoring the patient's response to therapy, and making any necessary adjustments to the plan of care. Registered dieticians often play a significant role in this process.
In simple words: This code covers a special type of liquid food given through a tube into a child's stomach.It's a complete food, providing all the nutrients a child needs if they can't eat normally.
This HCPCS code, B4161, represents a nutritionally complete enteral formula specifically designed for pediatric patients.The formula contains hydrolyzed or predigested amino acids and peptide chain proteins, along with fats, carbohydrates, vitamins, and minerals. Fiber may also be included. This formula is administered via an enteral feeding tube directly into the stomach or small intestine. It is intended for use when a child cannot receive adequate nutrition orally.
Example 1: A premature infant in the NICU requiring specialized nutrition due to inability to tolerate oral feedings., A child with cystic fibrosis experiencing malabsorption and requiring supplemental nutrients through an enteral feeding tube., A child with severe gastroesophageal reflux disease (GERD) unable to tolerate oral feedings without significant discomfort or aspiration.
* Physician's order specifying the need for enteral nutrition and the specific formula (B4161).* Documentation of the patient's nutritional status, including weight, height, and laboratory values (e.g., albumin, prealbumin).* Detailed records of the amount of formula administered daily.* Monitoring of the patient's tolerance to the formula, including any adverse effects.* Documentation of any adjustments made to the plan of care.
** This code is specifically for pediatric patients.For adult patients requiring a similar formula, use HCPCS code B4153.Always refer to the most current HCPCS codebook and payer-specific guidelines for accurate coding and billing.
- Payment Status: Active
- Specialties:Neonatology, Gastroenterology, Pediatric Surgery, Nutritional Support
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Skilled Nursing Facility