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See a sample rate comparisonHCPCS B4159 Fee Schedule
HCPCS B4159 is classified under Enteral and Parenteral Therapy, in the Enteral Formulas and Additives subgroup.
Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, 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 | $0.64 median of the 5 states in the free preview · View Medicaid rates for B4159 |
National average reimbursement for HCPCS B4159 by major payers:
$10.60
BCBS / Anthem
$1.90
UnitedHealthcare
$0.68
Aetna
$1.26
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS B4159.
HCPCS B4159
5 of 8 sample ratesHigher to lower in this preview
Aztec Urgent Care, LLC
Aztec Urgent Care LLC
$1.85Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$1.60Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$1.60Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$1.37Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$1.37Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS B4159 vs. Other Enteral Formulas and Additives Codes
The table lists codes related to B4159. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| B4158-HCPCS | Low | Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4159-HCPCS | Low | Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4160-HCPCS | Low | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS B4159. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the B4159 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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