Table of content for "Ef ped fluid and electrolyte" (HCPCS B4103)
General information on the “B4103” code
HCPCS Code: B4103
Long Description: Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit
Short Description: Ef ped fluid and electrolyte
Original information is taken from B4103 page
Pricing indicators
Pricing Indicator Code 1: 46 – Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts). Durable Medical Equipment, Prosthetics, Orthotics, Supplies And Surgical Dressings
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage Issues Manual Reference Section Number 1: 65-10
Coverage
Coverage: D – Special coverage instructions apply
Type of service
Berenson-Eggers Type of Service (BETOS): O1C – Enteral and parenteral
Type Of Service 1: E – Enteral/parenteral nutrients/supplies (eff 04/95)
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20050101
Code Effective Date: 20050101
Action Code: N – No maintenance for this code