B4162 HCPCS code: Enteral formula, for pediatrics, 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

B4162 is the HCPCS Level II code for enteral formula, for pediatrics, 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 $3.36 per service for B4162 across 11,835 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 158% from 2022 to 2024 (4,585 to 11,835 services). In 2024, 9 suppliers billed Medicare for B4162 (purchases), serving 0 beneficiaries.

Code details

Who bills B4162 (2024)

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

Medicare utilization for B4162, 2022–2024

States with the most B4162 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 B4162

• 2005-01-01: B4162 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 B4162?

B4162 is the HCPCS Level II code for enteral formula, for pediatrics, 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 ped specmetabolic inherit".

How much does Medicare pay for B4162?

In 2024, the average Medicare payment was $3.36 per service (average allowed $4.28).

Does Medicare cover B4162?

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

Which diagnoses support coverage for B4162?

Medicare policy articles that cite B4162 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

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Next steps

• Run a reimbursement report for a device billed under B4162
• Watch B4162 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for B4162

Sources: CMS HCPCS Level II release October 2026; 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.

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