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    v1.0.30
    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4189-parenteral-nutrition-premix-10-51g-protein
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    HCPCS Level II B4189: Compounded Parenteral Nutrition Premix (10–51 g protein)

    HCPCS Level II code B4189 describes a compounded parenteral nutrition solution containing amino acids and carbohydrates with electrolytes, trace elements, and vitamins (premix) formulated to provide 10 to 51 grams of protein; this represents a compounded total parenteral nutrition product supplied for parenteral administration and is typically billed for inpatient or outpatient infusion services, including hospital infusion centers and outpatient infusion clinics.

    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 typical patient is an adult with inadequate oral or enteral nutrition who requires inpatient or outpatient parenteral nutrition (PN) support. Example scenario: a 58-year-old postoperative patient after major bowel resection with prolonged ileus and high-output fistula, unable to tolerate enteral feeds for >7 days. The patient is evaluated by the surgical and nutrition support teams, orders for a compounded premixed parenteral nutrition solution are placed by the prescribing physician, and pharmacy compounds the PN bag labeled as B4189 containing amino acids (10–51 g protein equivalent), dextrose, electrolytes, trace elements, and vitamins. Typical workflow steps: initial nutrition assessment and laboratory evaluation (electrolytes, liver function, glucose, magnesium, phosphate), prescription of PN formulation and daily monitoring plan, sterile compounding in pharmacy under USP <797> conditions, nursing administration via central or peripheral intravenous access, daily multidisciplinary review and adjustment, and documentation of intake/output, complications, and clinical response.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36415Collection of venous blood by venipuncturePre-PN laboratory monitoring (electrolytes, glucose, hepatic panel) to guide formulation.
    36556Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or olderCommon access procedure to facilitate administration of PN in hospital settings.
    36561Placement of tunneled central venous catheter, by open or percutaneous techniqueUsed for longer-term PN access when prolonged home or outpatient PN is anticipated.
    99605Medication therapy management (initial 15 minutes, face-to-face)Pharmacist or clinician counseling for complex PN regimens and medication-nutrient interactions.
    96372Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)May be used for ancillary injections given during PN care (e.g., thromboprophylaxis) when applicable.

    Related Modifiers

    6 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…
    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…
    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
    261QP3300X
    207ZF0201X
    246XC2903X
    156F00000X
    251K00000X

    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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