Billing Enteral / Gastrostomy & Gloves, nos sterile - CPT A4927, B4149 - B4162

Enteral / Gastrostomy

The Enteral Feeding Supply Kit, Pump fed (code B4035) is limited to 31 units per month (1 unit equals 1 day). The Enteral Feeding Supply Kit, Gravity fed (code B4036) is limited to 30 units per month.

To bill a partial month for an Enteral Feeding Supply Kit, enter the first date of the billing cycle in the “from” date (Field 24A). Enter the same date for the “To” date (Field 24A also). Enter one unit for each day Field 24G. For example, to bill for March 12–31, enter a “From” date of March 12, a “To” date of March 12, and a “20” in Field 24G.

The following scenario shows how to bill continued services (rolling months) for code B4035 (a 31-day billing frequency). The same instructions would apply to code B4036, except a 30-day billing frequency would be used.


a) You begin your billing cycle on February 3. February has 28 days in it, and 31 days from February 3 is March 5. Therefore, March 5 will be the last day of your billing cycle. On the claim form, enter “February 3” (the first day of the billing cycle) as the From date and as the To date (Field 24A). Enter “31” in Field 24G.

b) The next 31-day billing cycle would start on March 6. March has 31 days in it, and 31 days from March 6 is April 5. Therefore, April 5 will be the last day of your billing cycle. On the claim form, enter “March 6” as the From date and as the To date (Field 24A). Enter “31” in Field 24G.

c) The next 31-day billing cycle would start on April 6. April has 30 days in it, and 31 days from April 6 is May 6. Therefore, May 6 will be the last day of your billing cycle. On the claim form, enter “April 6” as the From date and as the To date (Field 24A). Enter “31” in Field 24G.

Enteral Nutrition/Formula does not require prior authorization when the recipient has a feeding tube through which enteral feeding is administered.

If the recipient’s diagnosis is gastrostomy or other artificial opening of gastrointestinal tract, such as jejunostomy or attention to one of these sites (ICD-9 code V44.1, V44.4 V55.1 or V55.4), prior authorization is not required. Enter the appropriate ICD-9 code in Field 21 on the CMS-1500 claim form.

Leave blank Field 23. This bypass of the prior authorization requirement does not pertain to recipients in an institutional setting (e.g., acute care, NF or ICF/MR).

Refer to MSM Chapter 1300 for covered and non-covered services.

Bill enteral formulas monthly as prior authorized. On the claim form, enter the begin date of the billing cycle in both the “From” and “To” date fields (Field 24A). If the recipient has Medicare coverage and you billed Medicare more than one month on a claim line, bill Medicaid the same way. In all other instances (e.g., private insurance), you may need to bill Medicaid differently than the
primary insurance.

For the following Enteral Formula codes, 100 calories equals 1 unit. Enter the units in Field 24G on the CMS-1500 claim form.

• B4149 • B4157
• B4150 • B4158
• B4152 • B4159
• B4153 • B4160
• B4154 • B4161
• B4155 • B4162

For Feeding Tubes, use code B4087 to bill for standard gastrostomy/jejunostomy tubes and code B4088 without a modifier to bill for a low-profile gastrostomy/jejunostomy feeding tube. For the Low Profile Gastrostomy Feeding Tube, MIC-KEY® Button only, use B4088 with modifier BA. Use  B9998 to bill for Extension Sets. Prior authorization is required to exceed 1 unit every 3 months

Percutaneous Catheter/Tube Anchoring Devices (code A5200) and dressing holders (A4461 or A4463) used in conjunction with a gastrostomy or enterostomy tube are included in supply kit codes B4034-B4036 and may not be billed separately.

Gloves, Non-sterile, per 100 (Code A4927) One box contains 100 gloves. Therefore, one box of 100 gloves equals one unit for billing.