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    v1.0.30
    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4193-parenteral-nutrition-amino-acid-carbohydrate-premix-52-73g-protein
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    HCPCS Level II B4193: Parenteral Nutrition Amino Acid-Carbohydrate Premix 52–73g

    HCPCS Level II code B4193 describes a compounded parenteral nutrition premix containing amino acids and carbohydrates with electrolytes, trace elements, and vitamins, specified for formulations providing 52 to 73 grams of protein; the service represents a parenteral nutrition solution preparation intended for systemic intravenous administration and is typically provided in inpatient hospital or outpatient infusion center settings for patients requiring total or supplemental nutrition support.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult hospitalized with inadequate enteral intake who requires full parenteral nutrition. For example, a 62-year-old patient with small bowel obstruction and short bowel syndrome after multiple resections is NPO and develops malnutrition with serum albumin decline and negative nitrogen balance. The nutrition support team (physician, pharmacist, and registered dietitian) assesses caloric and protein needs, orders a compounded parenteral nutrition premix containing 52–73 grams of protein with amino acids, carbohydrates, electrolytes, trace elements, and vitamins. Pharmacy compounds the B4193 premix under sterile conditions, labels quantities and additives, and prepares it for central venous administration. Nursing verifies the order, inspects the bag, performs pump programming, and administers via an existing central venous catheter. Daily monitoring includes vital signs, intake/output, serum electrolytes, glucose, liver function tests, and weight; the physician adjusts composition and duration based on metabolic response and complication surveillance such as catheter-related infection, hyperglycemia, or electrolyte disturbances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36415Collection of venous blood by venipunctureLaboratory monitoring (electrolytes, glucose) required during PN therapy
    36556Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or olderCommon vascular access procedure when PN is started and no existing central access is available
    36561Insertion of tunneled central venous catheter, without subcutaneous port or pumpAlternative long-term venous access for prolonged PN
    99605Medication therapy management service(s) provided by a pharmacist, face-to-face with patient, initial 15 minutes, new patientPharmacist medication management and counseling related to PN regimen and interactions
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourCodes for infusion services used in reimbursement contexts for administration time when applicable

    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    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
    103T00000X
    207R00000X
    363A00000X
    225CA2400X
    281P00000X
    332S00000X
    207RA0002X
    207ZP0104X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    A09Infectious gastroenteritis and colitis, unspecified
    B20Human immunodeficiency virus [HIV] disease
    C18.9Malignant neoplasm of colon, unspecified
    C25.9Malignant neoplasm of pancreas, unspecified
    C80.1Malignant (primary) neoplasm, unspecified
    E40Kwashiorkor
    E42Marasmic kwashiorkor
    E43Unspecified severe protein-calorie malnutrition
    E44.0Moderate protein-calorie malnutrition
    E66.9Obesity, unspecified

    Showing 1–10 of 29

    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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