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See a sample rate comparisonHCPCS B4160 Fee Schedule
HCPCS B4160 is classified under Enteral and Parenteral Therapy, in the Enteral Formulas and Additives subgroup.
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
| Key Fact | Detail |
|---|---|
| Service Type | Enteral and Parenteral Therapy Enteral Formulas and Additives |
| Complexity Level | Low |
| Medicaid Fee Schedule | $0.67 median of the 7 states in the free preview · View Medicaid rates for B4160 |
National average reimbursement for HCPCS B4160 by major payers:
$9.51
BCBS / Anthem
$1.11
UnitedHealthcare
$0.50
Aetna
$0.82
Cigna
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HCPCS B4160
5 of 25 sample ratesHigher to lower in this preview
Dme Mart, LLC
Dme Mart LLC
$1.02Published rateDme Mart, LLC
Dme Mart LLC
$1.02Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$1.02Published rateEntramed, Inc, Sentido Health
Sentido Health
$0.64Published ratePatient Support Services, Inc, Lincare
Patient Support Services, Inc.
$0.64Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS B4160 vs. Other Enteral Formulas and Additives Codes
The table lists codes related to B4160. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| B4161-HCPCS | Low | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes 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 B4160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the B4160 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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