B4157 HCPCS code: Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

B4157 is the HCPCS Level II code for enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit. In 2024 Medicare paid an average of $5.40 per service for B4157 across 28,586 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. Medicare volume rose 165% from 2022 to 2024 (10,794 to 28,586 services). In 2024, 18 suppliers billed Medicare for B4157 (purchases), serving 23 beneficiaries; Florida, Minnesota, California accounted for 63% of services.

Code details

Who bills B4157 (2024)

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for B4157, 2022–2024

States with the most B4157 services (2024)

Medicare policy articles for this code

• A58833: Enteral Nutrition - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance

Covered diagnoses (21 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 21. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for B4157

• 2005-01-01: B4157 added to HCPCS Level II
• Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01

Frequently asked questions

What is HCPCS code B4157?

B4157 is the HCPCS Level II code for enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit. Short descriptor: "Ef special metabolic inherit".

How much does Medicare pay for B4157?

In 2024, the average Medicare payment was $5.40 per service (average allowed $6.89).

Does Medicare cover B4157?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for B4157?

Medicare policy articles that cite B4157 list 21 covered ICD-10-CM diagnosis codes across 1 article. The most cited include E08.69 (Diabetes mellitus due to underlying condition with other specified complication), E09.69 (Drug or chemical induced diabetes mellitus with other specified complication), E10.69 (Type 1 diabetes mellitus with other specified complication). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

Related B41 codes

• B4100 — Food thickener, administered orally, per ounce
• B4102 — Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
• B4103 — Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
• B4104 — Additive for enteral formula (e.g., fiber)
• B4105 — In-line cartridge containing digestive enzyme(s) for enteral feeding, each
• B4148 — Enteral feeding supply kit; elastomeric control fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
• B4149 — Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4150 — Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4152 — Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4153 — Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4154 — Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
• B4155 — Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.

Next steps

• Run a reimbursement report for a device billed under B4157
• Watch B4157 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for B4157

Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.

All B codes · HCPCS lookup