HCPCS Level II B4164: Parenteral Nutrition Dextrose Solution, Home Mix - OpenPayer

Summary & Overview

HCPCS Level II B4164: Parenteral Nutrition Dextrose Solution, Home Mix

HCPCS Level II code B4164 designates a home-mix parenteral nutrition solution composed of dextrose (carbohydrates) at concentrations of 50% or less, measured at 500 ml per billing unit. This code is used to bill the carbohydrate component of parenteral nutrition provided in the home infusion setting and is relevant for payers managing chronic nutritional support and transitional care from inpatient to home. Nationally, accurate coding of parenteral nutrition components affects coverage determinations, authorization workflows, and cost management for long-term home infusion therapy.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context, common modifiers used with HCPCS Level II codes, typical sites of service, and how this code fits into the broader home infusion service line. The publication also summarizes benchmarking considerations, coding nuances for component-based parenteral nutrition billing, and policy or coverage topics that commonly affect reimbursement and authorization for home-administered nutritional therapy.

Data not available in the input: associated taxonomies, specific ICD-10 diagnoses linked to this code, related codes, and detailed service-line placement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareB4164HCPCS Level IIhome infusionparenteral nutritiondextrose solutionnutrition supportbilling codeinfusion therapy

Billing Code Overview

HCPCS Level II code B4164 represents a parenteral nutrition solution containing carbohydrates (dextrose), 50% or less, provided as a home mix. The code quantity is defined such that 500 ml = 1 unit.

Service Type: Parenteral nutrition (carbohydrate component)

Typical Site of Service: Home infusion / patient residence

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A home infusion pharmacy dispenses a compounded parenteral nutrition (PN) solution containing dextrose (carbohydrates) at concentrations of 50% or less, packaged in 500 mL units billed as B4164. Typical patients include adults with chronic intestinal failure, short bowel syndrome, severe malabsorption, or prolonged postoperative ileus who cannot meet nutritional needs enterally. The clinical workflow: an outpatient clinician (gastroenterologist or nutrition support team) documents the indication, PN formulation, rate, and duration in the home infusion order. A registered dietitian/nutritionist calculates daily macronutrient and fluid needs. The home infusion pharmacy compounds and labels the B4164 500 mL unit(s), coordinates home delivery, and provides infusion supplies and instructions. Home nursing or the patient/caregiver performs catheter access, tubing setup, and pump programming per the infusion plan. Regular follow-up includes lab monitoring (electrolytes, glucose, liver function tests, triglycerides), weight and volume adjustments, and periodic reassessment by the prescribing clinician and nutrition support team.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when billing a professional component service associated with drug administration if applicable to facility/provider splits.

HCPCS B4104: Additive for Enteral Formula (Fiber)

HCPCS-B4103-PEDIATRIC-ENTERAL-FLUID-REPLACEMENT

HCPCS B4103: Pediatric Enteral Formula for Fluid and Electrolyte Replacement

HCPCS-B4082-NASOGASTRIC-TUBING-WITHOUT-STYLET

HCPCS B4082: Nasogastric Tubing Without Stylet

HCPCS-B4168-AMINO-ACID-35-HOME-PARENTERAL-NUTRITION-500ML

HCPCS B4168: Parenteral Nutrition Amino Acid 3.5% (500 mL) Home Mix

HCPCS-B4154-ENTERAL-NUTRITION-SPECIAL-METABOLIC-NEEDS

HCPCS B4154: Enteral Formula for Special Metabolic Needs

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

HCPCS B4102: Adult Enteral Fluid and Electrolyte Replacement Formula, 500 ml unit

HCPCS-B4148-ENTERAL-FEEDING-ELASTOMERIC-SUPPLY-KIT-PER-DAY

HCPCS B4148: Enteral Feeding Supply Kit for Elastomeric Control-Fed Systems, Per Day

HCPCS-B9006-PARENTERAL-NUTRITION-INFUSION-PUMP-STATIONARY

HCPCS B9006: Parenteral Nutrition Infusion Pump, Stationary

HCPCS-B4172-PARENTERAL-AMINO-ACID-HOME-MIX-500ML

HCPCS B4172: Parenteral Amino Acid Solution, 5.5%–7%, Home Mix

HCPCS-B9999-PARENTERAL-SUPPLIES-NOC

HCPCS B9999: NOC for Parenteral Supplies

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Taxonomy Code	Specialty	Notes
`2085R0200X`	Gastroenterology	Prescribes and manages PN for intestinal failure and malabsorption.
`207L00000X`	General Surgery	Places or revises central venous access devices for PN.
`163WL0500X`	Clinical Nutritionist/Dietitian	Calculates PN macronutrient and micronutrient formulations and monitors nutrition therapy.
`207K00000X`	Critical Care Medicine	Manages PN in complex critically ill patients during transitions to home PN when applicable.
`361H00000X`	Home Health Agency	Provides nursing services for home PN administration and monitoring.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K90.0`	Celiac disease	Malabsorption causing failure of enteral nutrition, may require PN.
`K91.89`	Other postprocedural complications and disorders of digestive system	Postoperative complications impairing enteral feeding leading to PN.
`K91.1`	Postoperative intestinal obstruction	May necessitate parenteral nutrition when enteral feeding is contraindicated.
`K91.2`	Enterocutaneous fistula	High-output fistulas often require PN for nutrition and bowel rest.
`K56.7`	Ileus, unspecified	Prolonged ileus can require temporary PN support.
`T81.4XXA`	Infection following a procedure, initial encounter	Catheter-related infection is a common PN complication requiring management.
`E86.0`	Dehydration	May accompany or complicate PN therapy and affect formulation and monitoring.
`R63.4`	Abnormal weight loss	Indication for nutrition support when enteral feeding is insufficient.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Used for routine laboratory monitoring of patients receiving PN (electrolytes, glucose, triglycerides).
`36561`	Therapeutic, prophylactic, or diagnostic injection; for catheter-related infusion (replacement/management) — tunneled central venous catheter care, dressing change (example)	Related to catheter maintenance or dressing changes required for ongoing PN administration at home.
`36000`	Introduction of needle or intracatheter, vein; simple (e.g., for placement of peripheral IV)	May be used when peripheral venous access is required for short-term infusions or blood draws associated with PN management.
`36410`	Venipuncture, for collection of blood specimens by venipuncture, by venous access device	Used for repeated lab monitoring drawn from existing access in PN patients.
`43770`	Jejunostomy, enteral feeding tube placement, percutaneous endoscopic (PEG-J)	Although enteral feeding is preferred, this code represents alternate access procedures when PN is considered due to enteral route failure; may appear in the care pathway when transitioning between modalities.

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