Summary & Overview
HCPCS B4199: Compounded Parenteral Nutrition Premix, >100g Protein
HCPCS Level II code B4199 represents a compounded parenteral nutrition premix containing amino acids and carbohydrates with electrolytes, trace elements and vitamins, formulated with more than 100 grams of protein and including preparation. This code applies to high-protein intravenous nutrition solutions used when enteral feeding is not feasible or insufficient, and it matters nationally because parenteral nutrition is a high-cost, clinically critical intervention for patients with significant nutritional needs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and coding scope. The publication outlines benchmark considerations and common payer coverage frameworks, highlights policy and billing implications for compounded parenteral nutrition premixes, and summarizes coding principles relevant to infusion therapy lines.
This summary provides clinicians, billers and policy analysts with a practical reference on what B4199 denotes, where it is commonly used, and what topics to expect in the full publication, including reimbursement benchmarks, coverage nuances among major payers, and the clinical scenarios that commonly justify use of a high-protein parenteral nutrition premix. Data not available in the input will be identified in the detailed sections of the full report.
Billing Code Overview
HCPCS Level II code B4199 describes a parenteral nutrition solution that is a premixed, compounded formulation containing amino acids and carbohydrates with electrolytes, trace elements and vitamins, and specified as over 100 grams of protein. The description indicates inclusion of preparation in the service.
Service Type: Compounded parenteral nutrition (high-protein premix)
Typical Site of Service: Hospital inpatient, hospital outpatient infusion center, or skilled nursing facility where compounded parenteral nutrition solutions are prepared and administered.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving B4199 is an adult or pediatric inpatient requiring total parenteral nutrition (TPN) because enteral feeding is contraindicated or insufficient. Example scenario: a 58-year-old male postoperative from extensive small bowel resection for ischemia with prolonged ileus and high output fistula. The surgical team determines the patient cannot meet metabolic needs enterally; the nutrition support service (physician and dietitian) prescribes a compounded parenteral nutrition solution containing amino acids (>100 grams protein), dextrose, electrolytes, trace elements, and vitamins. Pharmacy compounds the premix under sterile conditions in an IV admixture area, labels it with patient identifiers and infusion instructions, and delivers to the nursing unit. Nursing initiates infusion via a central venous catheter with pump programming and documents infusion start time, rate, and tolerance. The nutrition support team monitors laboratory trends (electrolytes, glucose, liver function, triglycerides), adjusts composition daily as clinically indicated, and documents ongoing medical necessity. Typical sites of service include inpatient acute care hospitals, long-term acute care hospitals, and skilled nursing facilities with capability for central line management and sterile compounding.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Not a valid modifier for professional/technical split; placeholder |