HCPCS B4164 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Enteral and Parenteral Therapy Parenteral Solutions and Supplies |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for B4164 |
National average reimbursement for HCPCS B4164 by major payers:
$19.90
$20.43
$19.58
$25.50
HCPCS B4164 vs. Other Parenteral Solutions and Supplies Codes
The HCPCS B4164 code is part of the Enteral and Parenteral Therapy services used for Parenteral Solutions and Supplies. 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 B4164 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 |
|---|---|---|
| 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 |
| B4168-HCPCS | Low | Parenteral nutrition solution; amino acid, 3.5%, (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 B4164. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the B4164 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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