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See a sample rate comparisonHCPCS B4162 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, 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 | View Medicaid rates for B4162 |
National average reimbursement for HCPCS B4162 by major payers:
$14.10
$4.13
$1.62
$2.46
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HCPCS B4162
5 of 8 sample ratesHigher to lower in this preview
Aztec Urgent Care, LLC
Aztec Urgent Care LLC
$4.15Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$3.84Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$3.84Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$3.46Published rateBorbas Surgical Supply, Inc
Borbas Surgical Supply Inc
$3.46Published rate
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See a sample payer proposalHCPCS B4162 vs. Other Enteral Formulas and Additives Codes
The HCPCS B4162 code is part of the Enteral and Parenteral Therapy services used for Enteral Formulas and Additives. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS B4162 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 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 |
| B4162-HCPCS | Low | Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
| B4164-HCPCS | Low | Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - homemix |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS B4162. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the B4162 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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