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    v1.0.30
    OpenPayerBilling CodesEnteral and Parenteral TherapyHCPCS hcpcs-b4197-parenteral-nutrition-premix-74-100g-protein
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    HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

    HCPCS Level II code B4197 describes a compounded parenteral nutrition solution containing amino acids and carbohydrates with electrolytes, trace elements, and vitamins—specified as a premix providing 74 to 100 grams of protein; service type is parenteral nutrition therapy/compounded intravenous nutrition and the typical site of service is infusion clinic, hospital outpatient department, or skilled nursing/home infusion setting.

    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 62-year-old hospitalized patient with postoperative ileus after major abdominal surgery is unable to tolerate enteral nutrition. The patient has been assessed by a multidisciplinary team (surgeon, hospitalist, registered dietitian, and pharmacy) and meets criteria for parenteral nutrition due to prolonged gastrointestinal dysfunction and inadequate oral/enteral intake. The clinician orders a compounded parenteral nutrition solution described by billing code B4197 — a premixed parenteral nutrition containing 74 to 100 grams of protein with amino acids, dextrose/carbohydrate, electrolytes, trace elements, and vitamins.

    Care workflow:

    • Initial assessment and documentation of inability to use the GI tract for nutrition and calculation of protein and caloric needs.

    • Order placement for B4197 by the prescribing physician or advanced practice provider with indications, rate, and duration.

    • Pharmacy compounding staff prepare the premix under sterile conditions, verify components, and label the admixture.

    • Nursing initiates central venous or peripheral parenteral administration per facility policy, monitors vital signs, fluid balance, electrolytes, and blood glucose, and documents tolerance.

    • Daily multidisciplinary review for adjustments, labs, and plans for transition to enteral or oral feeding when clinically appropriate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hourMay be used for initial infusion administration or documentation of infusion services when billing infusion time for parenteral nutrition administration in certain non-inpatient settings.
    96366Intravenous infusion; each additional hour (List separately in addition to code for primary procedure)Used to report extended infusion time beyond the initial hour when outpatient infusion billing is required.
    36415Collection of venous blood by venipunctureRoutine phlebotomy code for laboratory monitoring (electrolytes, glucose) associated with parenteral nutrition management.
    36556Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or olderPerformed when central venous access is required for administration of concentrated parenteral nutrition solutions.
    36561Insertion of tunneled central venous catheter for long-term use, with subcutaneous port or cuffUsed when long-term parenteral nutrition access is needed and a tunneled catheter or port is placed.

    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208D00000X
    208000000X
    363LF0000X
    3336C0002X
    163WW0000X
    125K00000X
    207RA0401X
    207ZC0008X

    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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