HCPCS code B4161: Enteral formula, for pediatrics, 100 calories

Learn more about how to properly use and bill HCPCS code B4161 from our short guide that comes with a list of documentation and billing requirements.

Use Code

Frequently asked questions

Coverage depends on the specific circumstances and adherence to Medicare's LCDs. For B4161 to be covered, the patient must have a permanent condition that prevents them from consuming or absorbing nutrients from an oral diet and requires this specialized formula.

No. B4161 is specifically for administration through an enteral feeding tube. If a formula is administered orally, it is typically not covered and would be billed with the BO modifier or A9270 (noncovered item or service).

The Pricing, Data Analysis, and Coding (PDAC) contractor for Medicare maintains a product classification list. It is crucial to check this list or contact the PDAC for guidance on which specific products are billable under B4161 to ensure correct coding.