HCPCS B5100: Parenteral Nutrition Hepatic Formulation (Hepatamine-Premix) - OpenPayer

Summary & Overview

HCPCS B5100: Parenteral Nutrition Hepatic Formulation (Hepatamine-Premix)

HCPCS Level II code B5100 denotes a compounded parenteral nutrition solution containing amino acids and carbohydrates with electrolytes, trace elements, and vitamins formulated for hepatic indications (hepatamine-premix). This code covers complex intravenous nutritional therapy that supports patients with liver-related metabolic needs and is used across inpatient, outpatient infusion, long-term care, and home infusion settings. Nationally, parenteral nutrition codes like B5100 matter because they capture high-cost, clinically complex therapy that requires specialized compounding, monitoring, and supply chain management.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and context on utilization and coverage patterns for hepatic parenteral nutrition formulations; a review of common billing considerations and service settings; and clinical context that explains when a compounded hepatic formulation may be selected versus other nutritional products. The publication highlights payment and policy factors that affect access and administration of compounded parenteral nutrition at scale, and outlines operational implications for providers and facilities that deliver intravenous nutrition services. Data not available in the input for specific rates, modifiers, taxonomies, ICD-10 pairings, and related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareB5100HCPCS Level IIparenteral nutritionhepaticcompounded solutionsinfusion therapyhome infusionhospital outpatientnutrition support

Billing Code Overview

HCPCS Level II code B5100 describes a compounded parenteral nutrition solution that includes amino acids and carbohydrates with electrolytes, trace elements, and vitamins, labeled for hepatic use as a hepatamine-premix. This code represents a compounded intravenous nutritional therapy formulation intended to provide comprehensive macronutrients and micronutrients for patients with hepatic-related nutritional needs.

Service type: Compounded parenteral nutrition solution (hepatic formulation)
Typical site of service: Hospital inpatient units, hospital outpatient infusion centers, long-term acute care facilities, skilled nursing facilities, and home infusion settings

Clinical & Coding Specifications

Clinical Context

A 62-year-old hospitalized patient with chronic liver disease and severe malnutrition is unable to tolerate enteral feeding due to persistent vomiting and gastroparesis. The attending hepatologist and nutrition support team order parenteral nutrition tailored to hepatic concerns using an amino acid and carbohydrate solution with electrolytes, trace elements, and vitamins, prepared as a hepatamine-premix formulation. Pharmacy compounds the sterile parenteral nutrition (PN) bag under USP <797> conditions, labels it, documents lot numbers and additives, and coordinates bedside administration via the patient’s existing central venous catheter. Nursing performs line access and pump programming, monitors glucose, electrolytes, fluid status, and liver function tests, and documents intake/output and tolerance. The interdisciplinary team reviews daily PN goals, adjusts electrolytes, trace elements, and vitamin dosing based on labs, and discontinues PN when enteral nutrition is feasible or metabolic goals are met.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when billing only the professional component of a service, if applicable to compound oversight or pharmacist clinical consult billed separately per payer policy.
`22`

HCPCS B4187: Omegaven, 10 grams lipids

HCPCS-B4035-ENTERAL-FEEDING-SUPPLY-KIT-PUMP-FED-PER-DAY

HCPCS B4035: Enteral Feeding Supply Kit, Pump-Fed, Per Day

HCPCS-B4193-PARENTERAL-NUTRITION-AMINO-ACID-CARBOHYDRATE-PREMIX-52-73G-PROTEIN

HCPCS B4193: Parenteral Nutrition Premix, 52–73 g Protein

HCPCS-B4160-PEDIATRIC-CALORICALLY-DENSE-ENTERAL-FORMULA

HCPCS Level II B4160: Pediatric Calorically Dense Enteral Formula

HCPCS-B4168-AMINO-ACID-35-HOME-PARENTERAL-NUTRITION-500ML

HCPCS B4168: Parenteral Nutrition Amino Acid 3.5% (500 mL) Home Mix

HCPCS-B4180-PARENTERAL-DEXTROSE-GREATER-THAN-50-HOME-MIX

HCPCS B4180: Parenteral Dextrose Solution >50% (Home Mix)

HCPCS-B4222-PARENTERAL-NUTRITION-HOME-MIX-DAILY-KIT

HCPCS B4222: Parenteral Nutrition Supply Kit, Home Mix, Per Day

HCPCS-B4102-ENTERAL-FLUID-ELECTROLYTE-REPLACEMENT-FORMULA-ADULT

HCPCS B4102: Adult Enteral Fluid and Electrolyte Replacement Formula, 500 ml unit

HCPCS-B9006-PARENTERAL-NUTRITION-INFUSION-PUMP-STATIONARY

HCPCS B9006: Parenteral Nutrition Infusion Pump, Stationary

HCPCS-B4153-ENTERAL-FORMULA-HYDROLYZED-PROTEIN-TUBE-FEEDING

HCPCS B4153: Enteral Formula, Hydrolyzed Protein, Tube Feeding

Showing 1–10 of 50

Taxonomy Code	Specialty	Notes
`308500000X`	Pharmacy	Compounding sterile PN solutions under USP standards; clinical oversight and preparation.
`207RH0000X`	Hepatology	Manages hepatic-specific PN formulations such as hepatamine-premix and monitors liver function.
`208000000X`	Internal Medicine	Hospitalist or inpatient internist overseeing nutritional plan and coordinating PN initiation and adjustments.
`364S00000X`	Nursing — Specialty: Infusion Therapy	Infusion nurses manage central line access, pump programming, and monitoring during PN administration.
`363L00000X`	Dietitian/Nutritionist	Clinical dietitians develop PN macronutrient and micronutrient goals and adjust formulations based on labs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E46`	Malnutrition, unspecified	Indicates need for nutrition support including PN when enteral intake is inadequate.
`K91.2`	Malabsorption due to intolerance, noninfective	Enteral intolerance leading to PN dependence when absorption or tolerance is inadequate.
`K57.20`	Diverticulosis of large intestine without perforation or abscess	Example abdominal pathology that may preclude enteral feeding and necessitate PN during recovery.
`G93.4`	Encephalopathy, unspecified	Severe encephalopathy may impair swallowing or enteral feeding safety, prompting PN.
`Z90.490`	Acquired absence of both small and large intestine	Surgical short bowel or intestinal loss commonly requires long-term PN support.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Advanced hepatic malignancy can cause cachexia and hepatic-specific PN formulations such as hepatamine-premix may be indicated.
`K91.83`	Acute pancreatitis, unspecified	Severe pancreatitis often requires bowel rest and PN when enteral feeding is contraindicated.
`R63.4`	Abnormal loss of weight	Objective finding that supports initiation of PN when combined with other clinical factors.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Used before or during PN therapy for baseline and ongoing laboratory monitoring of electrolytes, glucose, and liver function.
`36416`	Collection of capillary blood specimen (eg, finger, heel)	Point-of-care glucose monitoring frequently performed during PN infusion to adjust dextrose delivery.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; without subcutaneous port or pump, age 5 years or older	May be performed prior to PN initiation when central vascular access is required for hypertonic PN solutions.
`36561`	Exchange of peripherally inserted central venous catheter (PICC), age 5 years or older	Used when existing PICC requires replacement or exchange related to PN administration issues.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate	Example of counseling codes sometimes billed by providers managing comorbidities; not directly related to PN compounding but common in inpatient care — include only if counseling provided per payer rules.
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	Used for co-administered IV fluids or short infusions alongside PN in certain clinical workflows; selection depends on payer and setting.

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