2013 Parenteral and Enteral Nutrition  Items and Services (PEN) Fee Schedule,,,,
,,,,
,,,NATIONAL,
HCPCS,MODIFIER 1,MODIFIER 2,FEE SCHEDULE,SHORT DESCRIPTION
B4034,,,6.11,Enter feed supkit syr by day
B4035,,,11.65,Enteral feed supp pump per d
B4036,,,8.00,Enteral feed sup kit grav by
B4081,,,21.61,Enteral ng tubing w/ stylet
B4082,,,16.07,Enteral ng tubing w/o stylet
B4083,,,2.47,Enteral stomach tube levine
B4087,,,35.67,"Gastro/jejuno tube, std"
B4088,,,35.67,"Gastro/jejuno tube, low-pro"
B4149,,,1.57,EF blenderized foods
B4150,,,0.68,EF complet w/intact nutrient
B4152,,,0.55,EF calorie dense>/=1.5Kcal
B4153,,,1.91,EF hydrolyzed/amino acids
B4154,,,1.22,EF spec metabolic noninherit
B4155,,,0.95,EF incomplete/modular
B4164,,,19.10,Parenteral 50% dextrose solu
B4168,,,27.85,Parenteral sol amino acid 3.
B4176,,,53.89,Parenteral sol amino acid 7-
B4178,,,64.69,Parenteral sol amino acid >
B4180,,,27.42,Parenteral sol carb > 50%
B4185,,,12.63,Parenteral sol 10 gm lipids
B4189,,,199.85,Parenteral sol amino acid &
B4193,,,258.24,Parenteral sol 52-73 gm prot
B4197,,,314.40,Parenteral sol 74-100 gm pro
B4199,,,359.25,Parenteral sol > 100gm prote
B4216,,,8.68,Parenteral nutrition additiv
B4220,,,9.00,Parenteral supply kit premix
B4222,,,11.10,Parenteral supply kit homemi
B4224,,,28.11,Parenteral administration ki
B5000,,,13.37,Parenteral sol renal-amirosy
B5100,,,5.22,Parenteral sol hepatic-fream
B9000,NU,,1225.78,Enter infusion pump w/o alrm
B9000,RR,,112.63,Enter infusion pump w/o alrm
B9000,UE,,919.34,Enter infusion pump w/o alrm
B9002,NU,,1225.78,Enteral infusion pump w/ ala
B9002,RR,,118.71,Enteral infusion pump w/ ala
B9002,UE,,919.34,Enteral infusion pump w/ ala
B9004,NU,,2836.83,Parenteral infus pump portab
B9004,RR,,449.08,Parenteral infus pump portab
B9004,UE,,2127.62,Parenteral infus pump portab
B9006,NU,,2836.83,Parenteral infus pump statio
B9006,RR,,449.08,Parenteral infus pump statio
B9006,UE,,2127.62,Parenteral infus pump statio
E0776,NU,BA,101.94,Iv pole
E0776,NU,KE,118.28,Iv pole
E0776,RR,BA,25.79,Iv pole
E0776,RR,KE,29.94,Iv pole
E0776,UE,BA,76.47,Iv pole
E0776,UE,KE,88.70,Iv pole
