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HCPCS Codes for Abbott Nutrition Enteral Formulas

HCPCS Codes for Abbott Nutrition Enteral FormulasB4102 Enteral Formula, for Adults, Used to Replace Fluids and Electrolytes ( Clear Liquids)Ensure ClearEnsure Pre-SurgeryB4103 Enteral Formula, for Pediatrics, Used to Replace Fluids and Electrolytes ( Clear Liquids)Ensure ClearPedialyte AdvancedCare B4149 Enteral Formula, Manufactured Blenderized Natural Foods With Intact NutrientsPediaSure Harvest Ensure Harvest B4150 Enteral Formula, Nutritionally Complete With Intact NutrientsEnsure OriginalEnsure Compact Ensure High ProteinEnsure PowderJevity CalJevity CalOsmolite 1 CalOsmolite Cal Promote Promote With FiberB4152 Enteral Formula, Nutritionally Complete, Calorically Dense (Equal to or Greater Than Kcal/Ml) With Intact NutrientsEnsure Enlive Ensure PlusHi-CalJevity CalOsmolite CalTwoCal HNB4153 Enteral Formula, Nutritionally Complete, Hydrolyzed Proteins (Amino Acids And Peptide Chain)Perative Pivot CalVital CalVital AF CalVital CalVital High Protein B4154 Enteral Formula, Nutritionally Complete, for Special Metabolic Needs, Excludes Inherited Disease of MetabolismGlucerna CalGlucerna CalGlucerna CalGlucerna ShakeGlucerna Hunger Smart ShakeNepro with CARBSTEADY Oxepa Pulmocare Similac PM 60/40 Suplena with CARBSTEADY B4155 Enteral Formula, Nutritionally Incomplete/Mo

Jevity® 1.0 Cal Jevity® 1.2 Cal Osmolite® 1 Cal Osmolite® 1.2 Cal Promote® Promote® With Fiber B4152 Enteral Formula, Nutritionally Complete, Calorically Dense (Equal to or Greater Than 1.5 Kcal/Ml) With Intact Nutrients Ensure® Enlive® Ensure® Plus Hi-Cal Jevity® 1.5 Cal Osmolite® 1.5 Cal TwoCal® HN

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Transcription of HCPCS Codes for Abbott Nutrition Enteral Formulas

1 HCPCS Codes for Abbott Nutrition Enteral FormulasB4102 Enteral Formula, for Adults, Used to Replace Fluids and Electrolytes ( Clear Liquids)Ensure ClearEnsure Pre-SurgeryB4103 Enteral Formula, for Pediatrics, Used to Replace Fluids and Electrolytes ( Clear Liquids)Ensure ClearPedialyte AdvancedCare B4149 Enteral Formula, Manufactured Blenderized Natural Foods With Intact NutrientsPediaSure Harvest Ensure Harvest B4150 Enteral Formula, Nutritionally Complete With Intact NutrientsEnsure OriginalEnsure Compact Ensure High ProteinEnsure PowderJevity CalJevity CalOsmolite 1 CalOsmolite Cal Promote Promote With FiberB4152 Enteral Formula, Nutritionally Complete, Calorically Dense (Equal to or Greater Than Kcal/Ml) With Intact NutrientsEnsure Enlive Ensure PlusHi-CalJevity CalOsmolite CalTwoCal HNB4153 Enteral Formula, Nutritionally Complete, Hydrolyzed Proteins (Amino Acids And Peptide Chain)Perative Pivot CalVital CalVital AF CalVital CalVital High Protein B4154 Enteral Formula, Nutritionally Complete, for Special Metabolic Needs, Excludes Inherited Disease of MetabolismGlucerna CalGlucerna CalGlucerna CalGlucerna ShakeGlucerna Hunger Smart ShakeNepro with CARBSTEADY Oxepa Pulmocare Similac PM 60/40 Suplena with CARBSTEADY B4155 Enteral Formula, Nutritionally Incomplete/Modular NutrientsJuven Pro-Phree ProViMin RCF ProMod Liquid ProteinSimilac Human Milk FortifierNOTE: Each healthcare provider is ultimately responsible for verifying Codes , coverage, and payment policies used to ensure that they are accurate for the services and items provided.

2 Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance Codes for Abbott Nutrition Enteral FormulasB4157 Enteral Formula, Nutritionally Complete, for Special Metabolic Needs for Inherited Disease of MetabolismCyclinex -2 Glutarex -2 Hominex -2I-Valex -2 Ketonex -2 Phenex -2 Phenex -2 VanillaPropimex -2 Tyrex -2B4158 Enteral Formula, for Pediatrics, Nutritionally Complete With Intact NutrientsSimilac Advance Similac Sensitive Similac Pro-Sensitive Similac for Spit-Up Similac OrganicSimilac Pro-Advance Similac Go & Grow Similac Total ComfortSimilac for SupplementationB4159 Enteral Formula, for Pediatrics, Nutritionally Complete Soy Based With Intact NutrientsSimilac Soy Isomil Similac for DiarrheaSimilac Go & Grow Soy-Based FormulaB4160 Enteral Formula.

3 For Pediatrics, Nutritionally Complete Calorically Dense (Equal to or Greater Than Kcal/Ml) With Intact NutrientsPediaSure PediaSure CalPediaSure with FiberPediaSure Cal with FiberPediaSure Enteral Formula CalPediaSure Enteral Formula Cal with FiberSimilac NeoSure Similac Special Care 24 with IronSimilac Special Care 30 with IronB4161 Enteral Formula, for Pediatrics, Hydrolyzed/Amino Acids and Peptide Chain ProteinsEleCare InfantEleCare JrPediaSure Peptide CalPediaSure Peptide CalSimilac Alimentum Vital PeptideB4162 Enteral Formula, for Pediatrics, Special Metabolic Needs for Inherited Disease of MetabolismCalcilo XD Cyclinex -1 Glutarex -1 Hominex -1I-Valex -1 Ketonex -1 Phenex -1 Propimex -1 Tyrex -1 The following products may be used by children (using code B4162) or adults (using code B4157)Cyclinex -2 Glutarex -2 Hominex -2I-Valex -2 Ketonex -2 Phenex -2 Phenex -2 VanillaPropimex -2 Tyrex -2A9270 Ensure Max ProteinEnsure Surgery ShakeNOTE: Each healthcare provider is ultimately responsible for verifying Codes , coverage, and payment policies used to ensure that they are accurate for the services and items provided.

4 Providers should consult with the insurance plan for complete and accurate details concerning documentation for claims. Abbott Nutrition does not guarantee reimbursement by any third-party insurance plan and will not reimburse physicians or providers for claims denied by third-party insurance plans. 2021 Abbott March 2021 LITHO IN USA

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