Summary & Overview
HCPCS Level II B4160: Pediatric Calorically Dense Enteral Formula
HCPCS Level II code B4160 identifies a nutritionally complete, calorically dense enteral formula formulated for pediatric patients and administered via enteral feeding tube. This code captures products with intact nutrients (proteins, fats, carbohydrates, vitamins, minerals) that may include fiber and are billed by unit where 100 calories equals one unit. Nationally, enteral nutrition codes like B4160 matter because they affect coverage determinations, durable medical equipment and nutrition supplier billing, and care planning for medically complex children who require tube feeding.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what B4160 represents clinically, the common sites of service, and how units are defined. The publication outlines typical billing contexts and the elements stakeholders use when assessing claims and coverage for pediatric enteral nutrition. The report also summarizes available benchmarks and policy considerations relevant to coding, documentation, and supply management for nutritionally complete pediatric formulas delivered via enteral tube.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage edits.
Billing Code Overview
HCPCS Level II code B4160 describes an enteral formula for pediatrics that is nutritionally complete and calorically dense (≥ 0.7 kcal/ml) with intact nutrients. The formula includes proteins, fats, carbohydrates, vitamins, and minerals, may include fiber, and is intended for administration through an enteral feeding tube. The reporting unit is 100 calories = 1 unit.
Service Type: Enteral nutritional therapy for pediatric patients
Typical Site of Service: Home health care, pediatric long-term care facilities, and hospital settings where enteral tube feeding is provided
Clinical & Coding Specifications
Clinical Context
A 6-year-old child with chronic neurologic impairment and severe oropharyngeal dysphagia requires long-term enteral tube feeding. Care coordination begins in the pediatric clinic after assessment by pediatric gastroenterology and speech-language pathology. The child is admitted or evaluated in an outpatient infusion/enteral nutrition program for initiation or continuation of a nutritionally complete, calorically dense pediatric enteral formula. Orders specify B4160 (enteral formula, pediatrics, nutritionally complete, calorically dense, intact nutrients) dosed by calories, with documentation of tube type (gastrostomy or nasogastric), feeding regimen (continuous vs bolus), daily caloric goal, and tolerance. Nursing or a home health agency prepares and administers feeds via the enteral tube; quantity billed in units where 100 calories = 1 unit. Clinical workflow includes physician order entry, nutrition assessment (registered dietitian), formula selection, insurance authorization, delivery coordination with durable medical equipment or pharmacy, and periodic reassessment for growth, tolerance, and complications (aspiration, tube displacement, diarrhea).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no specific modifier applies |