HCPCS code B4150: Enteral Formula, administered through an enteral feeding tube, 100 calories

## **HCPCS code B4150 documentation requirements** To justify the medical necessity for B4150, providers must maintain thorough documentation that includes: - A standard written order (SWO) from the treating practitioner. - The patient's diagnosis and a detailed explanation of their medical condition to support the medical necessity of the particular route of administration and caloric requirements. - Confirmation that the patient has a permanent impairment (a long and indefinite duration) of the structures that normally allow food to reach the small bowel, or a disease that impairs digestion or absorption. - The medical record must substantiate the need for the specific type and quantity of formula ordered. - If a special formula (like those under other B-codes) is not used, the documentation should confirm that a standard formula is appropriate. - Documentation must be available upon request during audits.

## **B4150 billing requirements** Billing for B4150 requires adherence to specific guidelines: - **Units of service:** The code is billed in units of 100 calories. For example, if a patient is ordered 2,000 calories per day, the provider would bill 20 units per day. - **Administration method**: This code is for a formula administered via an enteral feeding tube. - **Modifiers:** Other modifiers may be necessary depending on the situation, such as KX to indicate that all coverage criteria have been met, or GA if a valid Advance Beneficiary Notice of Noncoverage (ABN) is on file. - **Bundled supplies:** The code for the enteral formula itself doesn't include the administration supplies (e.g., feeding bags, syringes, tubing). These are billed separately. It's crucial not to bill for these supplies separately using a miscellaneous code. - **SNF stay:** If the patient is in a skilled nursing facility (SNF) and the stay is covered by Medicare Part A, the SNF must bill for the enteral nutrition. Part B payment is not available in this scenario.

## **Other relevant codes** - B4149: Manufactured blenderized natural foods - B4152: Nutritionally complete, calorically dense formula - B4153: Nutritionally complete formula with hydrolyzed proteins (amino acids and peptide chains). - B4154: Nutritionally complete formula for special metabolic needs, excluding inherited metabolic diseases. - B4155: Nutritionally incomplete/modular nutrients. - B4034, B4035, B4036: Enteral feeding supply kits for syringe, pump, and gravity feeding, respectively. - B4105: In-line digestive enzyme cartridges.