B4189 HCPCS code: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix
B4189 is the HCPCS Level II code for parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix. In 2024 Medicare paid an average of $195.48 per service for B4189 across 54,617 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 1 per day on DME suppliers. Medicare volume rose 2% from 2022 to 2024 (53,707 to 54,617 services). In 2024, 258 suppliers billed Medicare for B4189 (purchases), serving 651 beneficiaries; California, New York, Illinois accounted for 31% of services.
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 B4189 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 258 |
| Referring clinicians | 665 |
| Medicare beneficiaries | 651 |
| States with claims | 41 |
| Share of services in top 3 states (California, New York, Illinois) | 31% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 297 | 683 |
| 2023 | 271 | 665 |
| 2024 | 258 | 651 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for B4189, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 53,707 | 683 | $223.98 | $176.72 |
| 2023 | 53,739 | 665 | $244.11 | $189.89 |
| 2024 | 54,617 | 651 | $250.68 | $195.48 |
States with the most B4189 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 6,790 | $196.60 |
| New York | 5,286 | $197.09 |
| Illinois | 4,915 | $197.24 |
| Texas | 3,813 | $194.68 |
| Pennsylvania | 3,337 | $196.96 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Published Contractor Policy |
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 B4189
- 1988-01-01: B4189 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 B4189?
B4189 is the HCPCS Level II code for parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix. Short descriptor: "Parenteral sol amino acid &".
How much does Medicare pay for B4189?
In 2024, the average Medicare payment was $195.48 per service (average allowed $250.68).
Does Medicare cover B4189?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of B4189 can be billed per day?
1 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
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Next steps
- Run a reimbursement report for a device billed under B4189
- Watch B4189 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for B4189
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.