Question 1

What is HCPCS code B4154?

Accepted Answer

HCPCS code B4154 is "Ef spec metabolic noninherit". Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Question 2

What category is B4154 in?

Accepted Answer

B4154 belongs to HCPCS Category B (Enteral and Parenteral Therapy).

Question 3

When should I use HCPCS code B4154?

Accepted Answer

Use B4154 when billing for ef spec metabolic noninherit. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is B4154 covered by Medicare?

Accepted Answer

Coverage for B4154 (Ef spec metabolic noninherit) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for B4154?

Accepted Answer

Documentation for B4154 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).