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    v1.0.30
    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4153-enteral-formula-hydrolyzed-protein-tube-feeding
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    HCPCS Level II B4153: Enteral Formula, Hydrolyzed Protein

    HCPCS Level II code B4153 describes a nutritionally complete enteral formula with hydrolyzed proteins (amino acids and peptide chains), including fats, carbohydrates, vitamins and minerals, may include fiber, and is intended for administration through an enteral feeding tube; billing is by unit where 100 calories = 1 unit, and the service is enteral nutrition support typically provided in inpatient hospital, long-term care, or home health settings via enteral feeding tube.

    For related coverage guidance, see recent payer policy updates: Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical Policy, Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interaction.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a medically complex adult or pediatric patient who requires tube feeding with an amino acid- or peptide-based nutritionally complete enteral formula due to severe protein intolerance, multiple food protein allergies, eosinophilic esophagitis, short bowel syndrome with malabsorption, or severe pancreatitis with impaired digestion. The product described by B4153 is supplied and billed in units where 100 kilocalories = 1 unit and is administered via an enteral feeding tube (nasogastric, nasojejunal, gastrostomy, or jejunostomy).

    A realistic clinical workflow: after the treating clinician documents medical necessity (intolerance to standard intact-protein formulas, diagnosis supporting use of hydrolyzed/amino-acid formulas, anticipated duration, and route of administration), the registered dietitian prescribes appropriate caloric needs and rate. The supplier dispenses the B4153 formula in the quantity consistent with the dietitian’s plan. Nursing or a home health clinician educates the patient/caregiver on tube care, administration schedule (bolus vs. continuous), and storage. Orders and documentation include the specific formula, calories per unit, number of units supplied, the enteral access device type, and supporting diagnoses in the medical record for audit and claims processing.

    Typical site of service: inpatient hospital, skilled nursing facility, long-term acute care, home health, or outpatient infusion/enteral therapy clinic depending on patient stability and discharge status.

    Typical modifiers used on claims reflect billing context (e.g., supplier, ordering practitioner, or unusual circumstances) and support medical necessity documentation and claim adjudication.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Insertion of gastrostomy tube, percutaneous, under imaging guidancePlacement of long-term enteral access prior to ongoing administration of B4153 formula.
    49450Removal of gastrostomy tubeRemoval of enteral access when enteral nutrition with B4153 is discontinued.
    43760Laparoscopy, surgical, gastrostomy, with or without insertion of gastrostomy tubeSurgical placement of gastrostomy tube for patients requiring chronic enteral formula administration.
    99070Supplies and materials (not otherwise classified) billed incident to a serviceUsed by facilities to bill non-covered ancillary supplies related to enteral feeding setup; payors vary on coverage.
    99406Smoking and tobacco use cessation counseling visit, intermediateExample of a concurrent counseling service that may be provided during teaching visits for enteral feeding (behavioral counseling codes vary by scenario).

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    P1Modifier P1 indicates an ASA Physical Status I — a normal healthy patient — and is appended to anesthesia CPT codes (00100–01999) based on the anesthesiologist’s clinical assessment. It documents the…- When to apply: Use modifier P1 on anesthesia CPT codes (00100–01999) when the anesthesia provider assigns ASA Physical Status I — a normal healthy patient (non‑smoker, minimal or no alcohol use).…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    251E00000X
    261QP2300X
    207RC0000X
    207RH0000X
    2084B0040X
    207RC0200X
    152WP0200X
    323P00000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    B15.0Hepatitis A with hepatic coma
    B15.9Hepatitis A without hepatic coma
    C22.0Liver cell carcinoma
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    E43Unspecified severe protein-calorie malnutrition
    E44.1Mild protein-calorie malnutrition
    E46Unspecified protein-calorie malnutrition
    E70.0Classical phenylketonuria
    E86.0Dehydration
    F50.9Eating disorder, unspecified

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 2

    10 rows

    PolicyPayerEffective Date
    Achalasia and Gastroesophageal Reflux Disease (GERD) - Minimally Invasive Procedures - Medical PolicyHealth-New-England2027-02-01
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Percutaneous electrical nerve field stimulation for disorders of gut-brain interactionpremerabluecrossofwashington2026-11-06
    Percutaneous Electrical Nerve Field Stimulation for Disorders of Gut-Brain Interactionpremerabluecrossofwashington2026-11-06
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01

    Related Codes

    HCPCS-B4034-ENTERAL-FEEDING-SYRINGE-FED-DAILY-KIT

    HCPCS Level II B4034: Enteral Feeding Supply Kit, Syringe-Fed Per Day

    HCPCS-B4035-ENTERAL-FEEDING-SUPPLY-KIT-PUMP-FED-PER-DAY

    HCPCS Level II B4035: Enteral Feeding Supply Kit, Pump-Fed, Per Day

    HCPCS-B4036-ENTERAL-FEEDING-SUPPLY-KIT-GRAVITY-FED-DAILY

    HCPCS Level II B4036: Enteral Feeding Supply Kit, Gravity-Fed, Per Day

    HCPCS-B4081-NASOGASTRIC-TUBING-WITH-STYLET

    HCPCS Level II B4081: Nasogastric Tubing With Stylet

    HCPCS-B4082-NASOGASTRIC-TUBING-WITHOUT-STYLET

    HCPCS Level II B4082: Nasogastric Tubing Without Stylet

    HCPCS-B4083-LEVINE-STOMACH-TUBE-NASOGASTRIC-SUPPLY

    HCPCS Level II B4083: Levine Stomach Tube

    HCPCS-B4087-GASTROSTOMY-JEJUNOSTOMY-TUBE-STANDARD

    HCPCS Level II B4087: Gastrostomy/Jejunostomy Feeding Tube, Standard

    HCPCS-B4088-LOW-PROFILE-GASTROSTOMY-JEJUNOSTOMY-TUBE

    HCPCS Level II B4088: Low-Profile Gastrostomy/Jejunostomy Tube

    HCPCS-B4100-FOOD-THICKENER-ORAL-PER-OUNCE

    HCPCS Level II B4100: Food Thickener, Oral, Per Ounce

    HCPCS-B4102-ENTERAL-FLUID-ELECTROLYTE-REPLACEMENT-FORMULA-ADULT

    HCPCS Level II B4102: Enteral Formula for Fluid and Electrolyte Replacement

    Showing 1–10 of 50

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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