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See a sample rate comparisonHCPCS B4154 Fee Schedule
HCPCS B4154 is classified under Enteral and Parenteral Therapy, in the Enteral Formulas and Additives subgroup.
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
| Key Fact | Detail |
|---|---|
| Service Type | Enteral and Parenteral Therapy Enteral Formulas and Additives |
| Complexity Level | Low |
| Medicaid Fee Schedule | $1.065 median of the 8 states in the free preview · View Medicaid rates for B4154 |
National average reimbursement for HCPCS B4154 by major payers:
$2.39
BCBS / Anthem
$1.13
UnitedHealthcare
$0.89
Aetna
$1.16
Cigna
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HCPCS B4154
5 of 25 sample ratesHigher to lower in this preview
Scottish Rite Childrens Medical Ctr, Children'S Healthcare Of Atlanta At Scottish Rite
Childrens Healthcare Of Atlanta Inc
$2.68Published rateKevin Schlessel
$1.74Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$0.88Published rateHospital Authority Of Washington County, Washington County Regional Medical Center
Hospital Authority Of Washington County
$0.72Published rateChristopher Raio
St Francis Hospital
$0.29Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS B4154 vs. Other Enteral Formulas and Additives Codes
The table lists codes related to B4154. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| B4153-HCPCS | Low | 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-HCPCS | Low | 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-HCPCS | Low | 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS B4154. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the B4154 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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