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    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4168-amino-acid-35-home-parenteral-nutrition-500ml
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    HCPCS Level II B4168: Parenteral Nutrition Amino Acid 3.5% (Home Mix)

    HCPCS Level II code B4168 describes a home-mix parenteral nutrition solution containing amino acids at 3.5% concentration, billed per 500 ml unit; the service is a parenteral nutrition infusion typically provided in the home setting and involves preparation and administration of intravenous amino acid solutions as part of total or supplemental nutrition therapy.

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

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    Clinical & Coding Specifications

    Clinical Context

    A home infusion patient with chronic intestinal failure or severe malabsorption receives an individualized parenteral nutrition regimen including an amino acid solution. Typical scenario: a 62-year-old patient with short bowel syndrome following multiple bowel resections is discharged from the hospital to home for long-term enteral/parenteral nutrition. The home infusion nurse coordinates with the prescribing physician and pharmacy to prepare a home-mix amino acid solution B4168 (3.5% amino acid, 500 mL unit) delivered via a central venous catheter. Prior to initiation, the clinician documents indication, weight-based dosing, electrolyte and dextrose components, and catheter care instructions. A home health clinician trains the patient or caregiver on aseptic technique, infusion pump operation, daily line care, and signs of complications such as catheter-related bloodstream infection or metabolic disturbances. Routine clinical workflow elements include periodic laboratory monitoring (electrolytes, liver function, triglycerides), prescription renewals, pharmacy compounding and verification, home delivery scheduling, and claims submission using B4168 for the amino acid component of the parenteral nutrition solution.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    90960Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug), initial; up to and including 1 hourMay be used when professional infusion services are provided alongside home parenteral nutrition initiation visits.
    90961Intravenous infusion, for therapy, prophylaxis, or diagnosis, each additional hour (List separately in addition to code for primary procedure)Used when infusion time exceeds the initial hour during an in-home infusion visit.
    99601Home infusion/specialty infusion therapy; initiation of home infusion therapy, for parenteral/enteral products not otherwise classified, per visitCommonly billed by home infusion agencies for start-of-care visits and patient/caregiver training associated with home parenteral nutrition.
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourMay be applicable if an infusion is administered in an outpatient setting related to nutrition therapy.
    36415Collection of venous blood by venipunctureRoutine laboratory monitoring (electrolytes, liver panel, triglycerides) performed before or during home infusion care.

    Related Modifiers

    8 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…
    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…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    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…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207Q00000X
    363L00000X
    207ZP0101X
    207RS0012X
    2084V0102X
    261QP0904X
    174V00000X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    C78.7Secondary malignant neoplasm of liver and intrahepatic bile duct
    C80.1Malignant (primary) neoplasm, unspecified
    E10.9Type 1 diabetes mellitus without complications
    E11.9Type 2 diabetes mellitus without complications
    E43Unspecified severe protein-calorie malnutrition
    E46Unspecified protein-calorie malnutrition
    E86.0Dehydration
    E87.70Fluid overload, unspecified
    I50.9Heart failure, unspecified

    Showing 1–10 of 27

    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
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    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
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01

    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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