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    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4161-pediatric-hydrolyzed-enteral-formula
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    HCPCS Level II B4161: Pediatric Hydrolyzed/Amino-Acid Enteral Formula

    HCPCS Level II code B4161 describes a pediatric enteral formula composed of hydrolyzed, amino-acid and peptide-chain proteins with fats, carbohydrates, vitamins and minerals, intended for administration through an enteral feeding tube; billing is per 100 calories as 1 unit. Service type: enteral nutrition formula supply; typical site of service: home health or inpatient/outpatient facility 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 typical patient is an infant or child with severe cow's milk protein allergy, eosinophilic esophagitis, short bowel syndrome, or malabsorption requiring tube feeding with a hypoallergenic, peptide- or amino-acid–based enteral formula. The product described by B4161 is administered via an enteral feeding tube (nasogastric, nasojejunal, gastrostomy, or jejunostomy) in inpatient, outpatient infusion/enteral nutrition clinics, or home health settings. Clinical workflow: clinician documents diagnosis and need for a specialized pediatric hydrolyzed/amino-acid enteral formula; durable medical equipment/supplies or enteral nutrition supplier processes prior authorization as required; dietitian prescribes caloric goal and feeding plan (volume per day translated to units where 100 calories = 1 unit); nursing or caregiver receives formula, verifies labeling and tubing, and administers via bolus or continuous pump per orders; documentation includes formula type, amount (units), route, start/stop times, tolerance, and any complications (aspiration, intolerance).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    49440Insertion of gastrostomy tube, percutaneous, without imaging (e.g., percutaneous endoscopic gastrostomy)Performed when long-term enteral access is required before ongoing administration of B4161 formula.
    49441Replacement of gastrostomy tube, percutaneous, without imagingRelated when feeding tube exchange is needed to continue enteral formula administration.
    49446Insertion of jejunostomy tube, percutaneous, without imagingUsed when postpyloric feeding is indicated and is performed before initiating formula delivery.
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourNot directly for enteral formula but included when concurrent IV hydration/therapy is required during inpatient management of intolerance.
    99401Preventive medicine counseling, individual; approximately 15 minutesNutrition counseling and caregiver education about formula preparation and tube feeding technique; billed when separate from supply.
    94664Demonstration and/or training for use of inhaler (not directly related)Data not applicable — Data not available in the input.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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
    363L00000X
    207Q00000X
    163WW0000X
    207RI0200X
    103TB0200X
    225XG0600X
    207QG0300X
    2084N0402X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    E43Unspecified severe protein-calorie malnutrition
    E44.0Moderate protein-calorie malnutrition
    E44.1Mild protein-calorie malnutrition
    E46Unspecified protein-calorie malnutrition
    E66.9Obesity, unspecified
    E70.0Classical phenylketonuria
    E71.0Maple-syrup-urine disease
    E83.42Hypomagnesemia
    F50.9Eating disorder, unspecified
    G80.1Spastic diplegic cerebral palsy

    Showing 1–10 of 24

    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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