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    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4157-enteral-formula-inherited-metabolic-disease
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    HCPCS Level II B4157: Enteral Formula for Inherited Metabolic Disease

    HCPCS Level II code B4157 describes a nutritionally complete enteral formula formulated for special metabolic needs related to inherited metabolic diseases; it includes proteins, fats, carbohydrates, vitamins, and minerals, may include fiber, and is intended for administration through an enteral feeding tube, billed per 100 calories as one unit. The service type is enteral nutrition therapy and the typical site of service is home or long-term care settings where enteral tube feeding is provided.

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

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    Clinical & Coding Specifications

    Clinical Context

    A 6-year-old child with a diagnosed inherited disorder of amino acid metabolism presents after genetic confirmation of phenylketonuria (PKU) and requires lifelong specialized enteral nutrition. The patient has poor oral intake and is managed at home with a gastrostomy tube placed during a prior hospitalization. The multidisciplinary workflow includes the metabolic specialist or pediatrician prescribing B4157 — an enteral formula formulated for special metabolic needs — with the prescription specifying caloric goals (e.g., 1,200 kcal/day = 12 units), macronutrient restrictions, and vitamin/mineral adjustments. A registered dietitian conducts initial caloric calculations and feeding regimen education with the caregiver, including tube feeding schedules, pump settings, and storage instructions. Durable medical equipment suppliers dispense the formula and bill payors using B4157 per unit (100 calories = 1 unit). Home health nursing may perform intermittent tube site checks and training reinforcement. Ongoing follow-up visits with the metabolic clinic assess growth parameters, plasma amino acid levels, and tolerance; formula adjustments are documented and prior authorization updates are submitted to payors as needed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Insertion of gastrostomy tube, percutaneous, endoscopicProcedure to establish long-term enteral access prior to ongoing use of B4157 via a gastrostomy tube
    43760Revision or replacement, gastrostomy, open or laparoscopicUsed when tube replacement or revision is required, which affects enteral formula delivery
    99406Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutesExample of a brief counseling CPT that may be provided during clinic visits; not directly related to formula but commonly billed during outpatient encounters
    97802Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutesNutrition services performed by a registered dietitian to assess and create the enteral formula regimen for B4157
    96127Brief emotional/behavioral assessment (e.g., depression screening)Screening often performed in chronic pediatric conditions to assess caregiver stress; adjunctive to overall care plan

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0206X
    103K00000X
    207RC0000X
    251B00000X
    282NR1301X
    261QA0005X
    261QR0208X
    101YM0800X

    Related ICD-10-CM Codes

    13 rows

    ICD-10-CM CodeDescription
    E00.9Congenital iodine-deficiency syndrome, unspecified
    E01.0Iodine-deficiency related diffuse (endemic) goiter
    E01.1Iodine-deficiency related multinodular (endemic) goiter
    E02Subclinical iodine-deficiency hypothyroidism
    E03.9Hypothyroidism, unspecified
    E70.0Classical phenylketonuria
    E70.1Other hyperphenylalaninemias
    E71.0Maple-syrup-urine disease
    E71.2Disorder of branched-chain amino-acid metabolism, unspecified
    E74.4Disorders of pyruvate metabolism and gluconeogenesis

    Showing 1–10 of 13

    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
    Esophageal Brush Biopsycaresourcegeorgia2026-12-01
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Gastric Pacing/Gastric Electrical Stimulation (GES)Cigna2026-11-15
    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
    Non-invasive Testing for Liver FibrosisModa Health2026-11-01
    Surgical Site of Care - Colonoscopy and Sigmoidoscopyregence2026-11-01

    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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