Reimbursement, ICD-10 Billing Codes for Medical Foods

Tools and resources to help educate your insurer about severe food allergies and why you may qualify to get reimbursement. Remember, our Nutricia Navigator team can help you navigate the reimbursement landscape.

Claims for Reimbursement usually require use of Reimbursement and Healthcare Common Procedures Coding System (HCPCS) Codes:

“Reimbursement billing codes” are terms you will often hear referenced. The codes are part of a system created by insurance companies to identify the nutritional product or category and to process claims. Some states require by law that certain diagnoses must be subject to reimbursement. Your doctor’s office may have more information regarding reimbursement in your state.

  • Neocate products are identified using HCPCS or Reimbursement Codes (see below).
  • Most insurance plans and government programs recognize these reimbursement billing codes.

In addition, there are diagnosis billing codes, also called ICD-10 codes, that identify the disease of the patient and may be required when submitting for reimbursement.

By providing accurate coding and complete documentation, you greatly increase your chance for coverage and payment.

Reimbursement and HCPCS Codes

As we explained above, some insurance companies and state programs that cover our products require a reimbursement or Healthcare Common Procedure Code (HCPCS). We’ve listed these codes here for your convenience.

Pediatric GI/Allergy

Product Nutricia
NDC-format Code* HCPCS
Neocate® Syneo Infant 111436 49735-0114-36 B4161
Neocate® Infant 12595 49735-0125-95 B4161
Neocate® Nutra 66739 49735-0167-39 B4161
Neocate® Junior Unflavored (without Prebiotics) Unflavored 11790 49735-0117-90 B4161
Neocate® Junior Unflavored (with Prebiotics) 12912 49735-0129-12 B4161
Neocate® Junior Vanilla 60627 49735-0106-27 B4161
Neocate® Junior Strawberry 86456 49735-0164-56 B4161
Neocate® Junior Tropical 12124 49735-0121-24 B4161
Neocate® Junior Chocolate 12690 49735-0126-90 B4161
Neocate® Splash Unflavored 84451 49735-0144-51 B4161 or B4153
Neocate® Splash Grape 122435 49735-0124-35 B4161 or B4153
Neocate® Splash Tropical Fruit 122437 49735-0124-37 B4161 or B4153
Neocate® Splash Orange-Pineapple 122436 49735-0124-36 B4161 or B4153


Other Nutritional Products

Duocal 10280 49735-0102-80 B4155
Phlexy-Vits 10685 49735-0106-85 A9270
Essential Amino Acid Mix 553342 49735-0114-90 B4155
Complete Amino Acid Mix 553341 49735-0101-24 B4155

*Nutricia North America does not represent these codes to be National Drug Codes (NDCs). NDC-format codes are product codes adjusted according to standard industry practice to meet the format requirements of pharmacy and health insurance systems.

ICD-10 Codes

Some insurance companies and state programs that cover our products require a diagnosis code from your doctor. Contact your healthcare professional for the ICD Codes for your GI and allergic conditions, and/or potential symptoms of these conditions.

Remember, our Nutricia Navigator team can help you make sense of this. Give them a call today at 1-800-365-7354.


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