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.

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HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

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Sign up for hcpcs B4197 policy alerts

Get alerted when payer policies referencing B4197 are released or updated.

Monitor payer policy activity

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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 Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used for initial infusion administration or documentation of infusion services when billing infusion time for parenteral nutrition administration in certain non-inpatient settings.
`96366`	Intravenous 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.
`36415`	Collection of venous blood by venipuncture	Routine phlebotomy code for laboratory monitoring (electrolytes, glucose) associated with parenteral nutrition management.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Performed when central venous access is required for administration of concentrated parenteral nutrition solutions.
`36561`	Insertion of tunneled central venous catheter for long-term use, with subcutaneous port or cuff	Used when long-term parenteral nutrition access is needed and a tunneled catheter or port is placed.

Related Modifiers

6 rows

Modifier	Description	When to Use
22	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
62	Modifier 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…
78	CPT 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…
80	CPT® 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	Specialty	Notes
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
3336C0002X	Clinic Pharmacy	A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
163WW0000X	Wound Care Registered Nurse	Nursing Service Providers · Registered Nurse
125K00000X	Advanced Practice Dental Therapist	An Advanced Practice Dental Therapist is:<br/>(1) A dental therapist who has completed additional training beyond basic dental therapy education and p…
207RA0401X	Addiction Medicine (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified b…
207ZC0008X	Clinical Informatics (Pathology) Physician	Physicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement…

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.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.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.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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Clinical & Coding Specifications

Clinical Context

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 Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used for initial infusion administration or documentation of infusion services when billing infusion time for parenteral nutrition administration in certain non-inpatient settings.
`96366`	Intravenous 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.
`36415`	Collection of venous blood by venipuncture	Routine phlebotomy code for laboratory monitoring (electrolytes, glucose) associated with parenteral nutrition management.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Performed when central venous access is required for administration of concentrated parenteral nutrition solutions.
`36561`	Insertion of tunneled central venous catheter for long-term use, with subcutaneous port or cuff	Used when long-term parenteral nutrition access is needed and a tunneled catheter or port is placed.

Related Modifiers

6 rows

Modifier	Description	When to Use
22	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…
62	Modifier 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…
78	CPT 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…
80	CPT® 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	Specialty	Notes
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
363LF0000X	Family Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
3336C0002X	Clinic Pharmacy	A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
163WW0000X	Wound Care Registered Nurse	Nursing Service Providers · Registered Nurse
125K00000X	Advanced Practice Dental Therapist	An Advanced Practice Dental Therapist is:<br/>(1) A dental therapist who has completed additional training beyond basic dental therapy education and p…
207RA0401X	Addiction Medicine (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified b…
207ZC0008X	Clinical Informatics (Pathology) Physician	Physicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement…

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.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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

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OpenPayer

HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

Sign up for hcpcs B4197 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

Sign up for hcpcs B4197 policy alerts

HCPCS B4197: Parenteral Nutrition Premix, 74–100 g Protein

Sign up for hcpcs B4197 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code B4197 represent and where is it typically used?

Which modifiers are commonly used with B4197 and when should they be applied?

What related CPT codes might be billed alongside B4197?

What diagnoses are listed as clinically relevant for billing B4197?

What is the documented clinical workflow for using B4197 in the inpatient setting?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code B4197 represent and where is it typically used?

Which modifiers are commonly used with B4197 and when should they be applied?

What related CPT codes might be billed alongside B4197?

What diagnoses are listed as clinically relevant for billing B4197?

What is the documented clinical workflow for using B4197 in the inpatient setting?

References