HCPCS Code B4035: Enteral Feeding Supply Kit; Pump‑Fed, Per Day

HCPCS code B4035 covers an enteral feeding supply kit, pump-fed, including syringe, tubing, dressings, and tape, per Medicare coverage criteria.

Use Code

## **What is HCPCS code B4035?** HCPCS Code B4035 refers to an enteral feeding supply kit, pump-fed for patients, billed per day. This feeding supply kit pump includes a variety of supplies necessary for enteral nutrition via a feeding pump, such as a feeding flushing syringe, administration set tubing, dressings, and tape. These items are used to administer enteral nutrition to patients requiring tube feeding through a pump system. The supplies covered under this code exclude the feeding tube itself and nutrient formulas, focusing instead on the daily necessary components for delivery and maintenance of the feeding system. This code is part of the larger category of enteral feeding supply allowances, enteral feeding supplies, and equipment, and is recognized by Medicare and other insurers for billing purposes. It represents a daily supply fee rather than a fixed kit, meaning supplies may vary day to day per patient needs. Only one unit of service (UOS) can be billed per day for B4035, and the code helps ensure providers are reimbursed for the ongoing supplies essential to enteral feeding management via pumps.

## **HCPCS code B4035 documentation requirements** The documentation requirements for HCPCS Code B4035 (enteral feeding supply kit pump fed per day) include: - A timely, appropriate, and complete Standard Written Order (SWO) signed and dated by the treating practitioner is required before submitting a claim. - The medical record must document medical necessity for the pump and supplies, including the beneficiary's diagnosis, clinical course, prognosis, duration, and functional limitations justifying enteral nutrition. It's essential to distinguish parenteral and enteral nutrition, as well as the supplies needed. - Documentation must confirm the method of administration corresponds to the code (kit pump fed per B4035). - A DME Information Form (DIF), CMS Form 10126, completed, signed, and dated by the supplier, must be kept on file and submitted electronically with the initial claim line. - Proof of delivery (signed delivery confirmation by member/caregiver or commercial carrier) should be contemporaneously prepared and retained. - Suppliers must monitor and document supply usage, replenishment contact with the patient, and avoid early delivery beyond allowed timelines (limited to not earlier than 5 days before supply exhaustion). - Only one unit of service (UOS) per day is billable; claims exceeding this will be denied as excess units. - All documentation must be available upon audit and support that the supplies are medically necessary and used as prescribed to avoid claim denials or recoupments. These requirements align with CMS guidelines and ensure proper billing and reimbursement for enteral feeding supply kit pump services under HCPCS Code B4035.

## **HCPCS code B4035 billing requirements** The billing requirements for HCPCS Code B4035, which covers the enteral feeding supply kit for pump-fed patients, include the following key points: - Only one unit of service (UOS) per day can be billed for B4035 since this code represents a daily supply allowance, not a fixed kit. Claims with more than one UOS per day will be denied. - The supplies included in B4035 are all-inclusive for a daily allowance, covering feeding/flushing syringes, tubing, dressings, tape, etc., but excluding the feeding tube and enteral nutrient formulas. - Billing must correspond to the method of administration, i.e., pump-fed supplies must be billed with B4035 (not syringe or gravity codes). - A valid, timely, and complete prescription/order signed and dated by the treating provider must be on file before billing. - Suppliers must maintain proof of delivery, such as a signed delivery confirmation by the member/caregiver or a commercial carrier document, contemporaneously prepared. - Supplies should be dispensed in a reasonable quantity, typically up to a 31-day supply, with no early delivery beyond 5 days before exhaustion. - Claims must align with documented medical necessity, including relevant clinical information, and must be supported by adequate documentation available for audit. - If the enteral pump is beneficiary-owned, this must be noted on claims for supplies accordingly. - When multiple products with the same HCPCS code are provided, units of service on claims should reflect the total quantity provided, and any excess quantities beyond medical necessity require special modifiers and possibly an Advance Beneficiary Notice (ABN). These billing requirements ensure compliance with Medicare guidelines and help prevent claim denials or recoupments related to HCPCS Code B4035.

## **Other relevant codes** Other relevant HCPCS codes related to enteral feeding supplies and equipment include the following: - **B4034**: Enteral feeding supply kit; syringe fed, per day (includes feeding/flushing syringe, administration set tubing, dressings, tape). - **B4036**: Enteral feeding supply kit; gravity fed, per day (similar supplies for gravity feeding method). - **B9998**: Not Otherwise Classified (NOC) for enteral supplies, used when no specific code exists for a particular supply item. - **B4105**: Immobilized lipase cartridge used with enteral feeding pumps for patients with exocrine pancreatic insufficiency. - **B4150 and B4152**: Enteral formulas, nutritionally complete, with B4152 representing calorically dense formulas (≥1.5 kcal/ml). - **B9002**: Enteral nutrition infusion pump with alarm. - Pediatric-specific enteral formulas codes such as B4159, B4160, B4161, and B4162 cover various pediatric nutritional needs. - Additional feeding tubes codes, such as B4081 and B4082, for nasogastric tubing with or without a stylet.

Frequently asked questions

B4035 is not a CPT code, but an HCPCS code for an enteral feeding supply kit for pump-fed patients, billed on a per-day basis. It includes feeding/flushing syringes, administration set tubing, dressings, and tape required for enteral nutrition via a pump system.

Medicare generally does not cover dietary thickening agents used to alter the consistency of liquids for patients with swallowing difficulties, as these are considered nutritional supplements or non-medical supplies.

Enteral nutrition supplies are billed under HCPCS codes such as B4034 (syringe-fed supply kit), B4035 (pump-fed supply kit), and B4036 (gravity-fed supply kit), depending on the method of administration.

Yes, Medicare covers enteral nutrition, including supplies and equipment, when medically necessary and properly documented. Coverage includes feeding pumps, tubing, and supplies (but excludes nutrients themselves unless meeting specific criteria).