B4178 HCPCS code: Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix
B4178 is the HCPCS Level II code for parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix. In 2024 Medicare paid an average of $63.79 per service for B4178 across 1,195 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 86% from 2022 to 2024 (8,366 to 1,195 services). In 2024, 5 suppliers billed Medicare for B4178 (purchases), serving 0 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | B codes — Enteral and parenteral therapy |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 39 — DMEPOS: parenteral and enteral nutrition |
| BETOS category | O1C — Enteral and parenteral nutrition |
| Added | 1988-01-01 |
| Last action effective | 2002-01-01 |
Who bills B4178 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 5 |
| Referring clinicians | 11 |
| Medicare beneficiaries | 0 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 5 | 0 |
| 2023 | 11 | 15 |
| 2024 | 5 | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for B4178, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 8,366 | 0 | $10.48 | $8.28 |
| 2023 | 1,540 | 15 | $78.10 | $61.23 |
| 2024 | 1,195 | 0 | $81.38 | $63.79 |
States with the most B4178 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New Jersey | 611 | $63.92 |
| Alaska | 554 | $63.91 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Clinical: Data |
Medicare policy articles for this code
- A58836: Parenteral Nutrition (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for B4178
- 1988-01-01: B4178 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 B4178?
B4178 is the HCPCS Level II code for parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix. Short descriptor: "Parenteral sol amino acid >".
How much does Medicare pay for B4178?
In 2024, the average Medicare payment was $63.79 per service (average allowed $81.38).
Does Medicare cover B4178?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of B4178 can be billed per day?
2 on DME suppliers (NCCI medically unlikely edits).
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 B4178
- Watch B4178 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for B4178
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.