Summary & Overview
HCPCS B4162: Pediatric Enteral Formula for Metabolic Disorders
HCPCS Level II code B4162 identifies an enteral nutrition formula designed for pediatric patients with inherited metabolic disorders. It captures specialized liquid formulas that provide proteins, fats, carbohydrates, vitamins and minerals — and may include fiber — delivered via enteral feeding tube. The code measures units by calorie (100 calories = 1 unit), which matters for accurate billing and supply authorization.
Nationally, B4162 is important for pediatric metabolic care coordination, coverage determinations for durable medical supplies and nutritional products, and for managing high-cost, condition-specific nutrition therapies. Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare.
Readers will find a concise explanation of what the code represents, typical sites of service, and the clinical context for use in inherited metabolic disease management. The publication reviews billing benchmarks and coverage considerations, outlines common modifiers used with HCPCS Level II codes, and summarizes implications for care teams, payers, and supply vendors. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code B4162 describes an enteral formula for pediatrics formulated for special metabolic needs related to inherited metabolic diseases. The product includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, and is administered through an enteral feeding tube. The billing metric for this product is 100 calories = 1 unit.
Service Type: Enteral nutrition formula provision for pediatric metabolic disorders
Typical Site of Service: Home health or institutional inpatient/outpatient settings where enteral tube feeding is provided, including pediatric long-term care and specialty metabolic clinics.
Clinical & Coding Specifications
Clinical Context
A pediatric patient with an inherited metabolic disorder (for example, branched-chain organic acidemia or urea cycle disorder) requires long-term tube feeding with a specialized enteral formula tailored to metabolic needs. The child is fed via a gastrostomy tube at home and receives formula prescriptions from a pediatric metabolic specialist. The clinical workflow: initial metabolic evaluation and diagnosis by genetics/metabolic medicine, formulation selection by the metabolic dietitian, prescription of enteral formula with specific caloric units (billing units defined as 100 calories = 1 unit), training of caregivers on tube feeding technique and storage, periodic follow-up visits to assess growth, laboratory monitoring for metabolic control, and adjustments to formula volume or composition as clinical status changes. Durable medical equipment suppliers or home infusion/enteral nutrition providers dispense the formula in coordination with the prescribing clinician. Documentation includes diagnosis, prescribed formula name and calorie concentration, total daily calories and units, route via enteral feeding tube, caregiver education, and plan for reassessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/standard billing | Use when no specific modifier applies to the service |
22 |