
2002 Parenteral and Enteral Nutrition  Items and Services (PEN) Fee Schedule

                        NATIONAL
HCPCS   MODIFIERMODIFIERFEE SCHEDULE SHORT DESCRIPTION

B4034                            5.60Enter feed supkit syr by day
B4035                           10.67Enteral feed supp pump per d
B4036                            7.31Enteral feed sup kit grav by
B4081                           19.78Enteral ng tubing w/ stylet
B4082                           14.73Enteral ng tubing w/o stylet
B4083                            2.25Enteral stomach tube levine
B4084                           16.52Gastrostomy/jejunostomy tubi
B4085                           37.48Gastrostomy tube w/ring each
B4086                           32.66Gastrostomy/jejunostomy tube
B4150                            0.61Enteral formulae category i
B4151                            1.43Enteral formulae cat1natural
B4152                            0.51Enteral formulae category ii
B4153                            1.74Enteral formulae categoryIII
B4154                            1.12Enteral formulae category IV
B4155                            0.87Enteral formulae category v
B4156                            1.24Enteral formulae category vi
B4164                           15.08Parenteral 50% dextrose solu
B4168                           21.96Parenteral sol amino acid 3.
B4176                           42.51Parenteral sol amino acid 7-
B4178                           51.04Parenteral sol amino acid >
B4180                           21.61Parenteral sol carb > 50%
B4184                           70.86Parenteral sol lipids 10%
B4186                           94.48Parenteral sol lipids 20%
B4189                          157.66Parenteral sol amino acid &
B4193                          203.73Parenteral sol 52-73 gm prot
B4197                          248.02Parenteral sol 74-100 gm pro
B4199                          283.42Parenteral sol > 100gm prote
B4216                            6.85Parenteral nutrition additiv
B4220                            7.10Parenteral supply kit premix
B4222                            8.75Parenteral supply kit homemi
B4224                           22.19Parenteral administration ki
B5000                           10.54Parenteral sol renal-amirosy
B5100                            4.12Parenteral sol hepatic-fream
B9000   NU                    1121.97Enter infusion pump w/o alrm
B9000   RR                     103.10Enter infusion pump w/o alrm
B9000   UE                     841.47Enter infusion pump w/o alrm
B9002   NU                    1121.97Enteral infusion pump w/ ala
B9002   RR                     108.66Enteral infusion pump w/ ala
B9002   UE                     841.47Enteral infusion pump w/ ala
B9004   NU                    2238.01Parenteral infus pump portab
B9004   RR                     354.30Parenteral infus pump portab
B9004   UE                    1678.51Parenteral infus pump portab
B9006   NU                    2238.01Parenteral infus pump statio
B9006   RR                     354.30Parenteral infus pump statio
B9006   UE                    1678.51Parenteral infus pump statio
E0776   NU      XA              93.30Iv pole
E0776   RR      XA              23.62Iv pole
E0776   UE      XA              69.98Iv pole
