2024 HCPCS Code B4103

Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit

Short Description	Ef ped fluid and electrolyte
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	January 01, 2005
HCPCS Code Added Date	January 01, 2005
HCPCS Pricing Indicator Code	46 - Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts)
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number	65-10
HCPCS Type Of Service Code	E - Enteral/parenteral nutrients/supplies (eff 04/95)
HCPCS Anesthesia Base Unit Quantity	0