Question 1

What is HCPCS code B4159?

Accepted Answer

HCPCS code B4159 is "Ef ped complete soy based". Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Question 2

What category is B4159 in?

Accepted Answer

B4159 belongs to HCPCS Category B (Enteral and Parenteral Therapy).

Question 3

When should I use HCPCS code B4159?

Accepted Answer

Use B4159 when billing for ef ped complete soy based. 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 B4159 covered by Medicare?

Accepted Answer

Coverage for B4159 (Ef ped complete soy based) 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 B4159?

Accepted Answer

Documentation for B4159 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).