Summary & Overview
HCPCS B4187: Omegaven, 10 grams lipids
HCPCS Level II code B4187 denotes Omegaven, a 10-gram lipid emulsion used as part of parenteral nutrition. This code captures the supply component for intravenous fish-oil–based lipids and matters for national billing and coverage because specialty lipid products are distinct from standard lipid emulsions and often involve differing clinical indications, utilization patterns, and payer coverage policies. Specialty lipid formulations can affect cost of care and clinical outcomes for patients requiring intravenous nutrition, including those with intestinal failure or parenteral nutrition–associated complications.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what this code represents, payer landscape considerations, typical sites of service, and the types of benchmarks and policy items commonly associated with specialty parenteral lipid billing. The publication outlines common modifiers and coding considerations (listed separately), potential clinical contexts where Omegaven is used, and references to related billing practices. Data not available in the input indicates where specific payer policies, utilization rates, or associated taxonomies and diagnosis lists would normally appear.
Billing Code Overview
HCPCS Level II code B4187 represents Omegaven, 10 grams lipids, a parenteral lipid emulsion used as a component of intravenous nutrition. The service type is parenteral nutrition supply — lipid emulsion. The typical site of service is hospital inpatient or hospital outpatient infusion, and other settings where intravenous lipid therapy is administered, including specialized infusion centers.
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Clinical & Coding Specifications
Clinical Context
A hospitalized neonate or adult patient with severe intestinal failure or short bowel syndrome receiving parenteral nutrition develops or is at high risk for essential fatty acid deficiency, hypertriglyceridemia with intolerance to standard soybean oil–based lipid emulsions, or severe omega-3–deficiency–related complications. The clinical workflow begins with nutrition consult and order for parenteral lipid supplementation. Pharmacy verifies prescription for B4187 (Omegaven, 10 grams lipids), prepares aseptic intravenous admixture, and documents lot and expiration. Administration occurs via central venous catheter or peripheral IV during total parenteral nutrition (TPN) infusion or as supplemental lipid infusion. Vital signs and triglyceride levels are monitored before and during therapy; dosing adjustments are based on weight, clinical response, and laboratory monitoring. Documentation includes indication, dose (number of B4187 units), route, lot number, and patient tolerance. Billing uses B4187 for each 10 g unit of Omegaven, with applicable modifiers to indicate service circumstances, and corresponding ICD-10 diagnosis codes to justify medical necessity for payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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