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
Item
Reimbursement
Code*
HCPCS
Code
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) 11790 49735-0117-90 B4161
Neocate® Junior with Prebiotics (Unflavored) 12912 49735-0129-12 B4161
Neocate® Junior with Prebiotics (Vanilla) 60627 49735-0106-27 B4161
Neocate® Junior with Prebiotics (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
Neocate® Splash (Grape) 122435 49735-0124-35 B4161
Neocate® Splash (Tropical Fruit) 122437 49735-0124-37 B4161
Neocate® Splash (Orange-Pineapple) 122436 49735-0124-36 B4161

 

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

 

*US Reimbursement codes listed above have been submitted by Nutricia North America to US data warehouses based on the standard format. These codes are not NDC numbers.

ICD-10 Codes

Some insurance companies and state programs that cover our products require a diagnosis code from your doctor. Contact your health care professional or your ICD Codes.  Remember, our Nutricia Navigator team can help you make sense of this. Give them a call today at 1-800-365-7354, Option 8.

 

Join Neocate Footsteps

Whether you are new to food allergies and want to get to know our products, or you need help with a lifestyle change, for new ideas to .

Join Neocate Footsteps

 
   
 
X

The content you are trying to access is intended for healthcare professionals only.

Are you a healthcare professional?