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Did you know?
All Nutricia products are available for convenient home delivery directly from Nutricia North America. Consumers can call our toll free number or visit one of our websites.
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For additional information, please call our Nutrition Information Department
United States:
(800) 365-7354
Canada:
(877) 636-2283 |
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HCPCS codes
Some
insurance companies and state programs that cover our products
require a reimbursement or Healthcare Common Procedure Code (HCPC).
These codes are listed here for your convenience.
Pediatric
GI/Allergy |
Product |
Nutricia Item |
Reimbursement |
HCPCS Code |
Neocate Infant Formula |
10804 |
49735-0108-04 |
B4161 |
Neocate Infant with DHA and ARA |
12595 |
49735-0125-95 |
B4161 |
Neocate Nutra |
12910 |
49735-0129-10 |
B4161 |
Neocate One+ Powder |
11048 |
49735-0110-48 |
B4161 |
Neocate Junior (Unflavored) |
11790-USA |
49735-0117-90 |
B4161 |
Neocate Junior with Prebiotics |
12912 |
49735-012912 |
B4161 |
Neocate Junior (Tropical Fruit) |
12124-USA |
49735-0121-24 |
B4161 |
Neocate Junior (Chocolate) |
12690 |
49735-0126-90 |
B4161 |
EO28 Splash (Grape) |
12670 |
49735-0126-70 |
B4161 |
EO28 Splash (Tropical Fruit) |
12666 |
49735-0126-66 |
B4161 |
EO28 Splash (Orange-Pineapple) |
11050 |
49735-0110-50 |
B4161 |
Pepdite Junior (Unflavored) |
11766 |
49735-0117-66 |
B4161 |
Pepdite Junior (Banana) |
11780 |
49735-0117-80 |
B4161 |
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Metabolics |
Analog Range |
Product |
Code |
Code |
HCPCS Code |
XPhe Analog, now Periflex Infant |
118326 |
49735-0183-26 |
B4162 |
MSUD Analog |
118302 |
49735-0183-02 |
B4162 |
XPhe, XTyr Analog |
118301 |
49735-0183-01 |
B4162 |
XPTM Analog |
118843 |
49735-0188-43 |
B4162 |
XMTVI Analog |
118303 |
49735-0183-03 |
B4162 |
XMet Analog |
118327 |
49735-0183-27 |
B4162 |
XLys, XTrp Analog |
118328 |
49735-0183-28 |
B4162 |
XLeu Analog |
118361 |
49735-0183-61 |
B4162 |
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Maxamaid Range |
XPhe Maxamaid, orange |
117792 |
49735-0177-92 |
B4162 |
XPhe Maxamaid, unflavored |
117793 |
49735-0177-93 |
B4162 |
XPhe Maxamaid, strawberry |
117794 |
49735-0177-94 |
B4162 |
MSUD Maxamaid |
117785 |
49735-0177-85 |
B4162 |
XPhe, XTyr Maxamaid |
117786 |
49735-0177-86 |
B4162 |
XMTVI Maxamaid |
117785 |
49735-0177-85 |
B4162 |
XMet Maxamaid |
117787 |
49735-0177-87 |
B4162 |
XLys, XTrp Maxamaid |
117780 |
49735-0177-80 |
B4162 |
XLeu Maxamaid |
117791 |
49735-0177-91 |
B4162 |
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Maxamum Range |
XPhe Maxamum, orange (cans) |
118324 |
49735-0183-24 |
B4157 or B4162 |
XPhe Maxamum, unflavored (cans) |
118323 |
49735-0183-23 |
B4157 or B4162 |
XPhe Maxamum, orange (sachets) |
12312 |
49735-0123-12 |
B4157 or B4162 |
XPhe Maxamum, unflavored (sachets) |
12311 |
49735-0123-11 |
B4157 or B4162 |
XPhe Maxamum Drink, berry |
12524 |
49735-0125-24 |
B4157 or B4162 |
XPhe Maxamum Drink, orange |
12551 |
49735-0125-51 |
B4157 or B4162 |
MSUD Maxamum |
117789 |
49735-0177-89 |
B4157 or B4162 |
XMTVI Maxamum |
117779 |
49735-0177-79 |
B4157 or B4162 |
XMet Maxamum |
117795 |
49735-0177-95 |
B4157 or B4162 |
XLys,XTrp Maxamum |
117788 |
49735-0177-88 |
B4157 or B4162 |
XLeu Maxamum |
117790 |
49735-01-7790 |
B4157 or B4162 |
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Lophlex |
Lophlex, Berry |
12169 |
49735-0121-69 |
B4155 |
Lophlex, Orange |
12167 |
49735-0121-67 |
B4155 |
PKU Lophlex LQ |
119535 |
49735-0195-35 |
B4157 or B4162 |
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Periflex/Acerflex |
Periflex Infant, formerly XPhe Analog |
118326 |
49735-0183-26 |
B4162 |
Periflex Junior, unflavored |
118308 |
49735-018308 |
B4162 |
Periflex Junior, orange |
118310 |
49735-0183-10 |
B4162 |
Periflex Junior, chocolate |
118309 |
49735-0183-09 |
B4162 |
Periflex Advance, unflavored |
118305 |
49735-0183-05 |
B4162 or B4157 |
Periflex Advance, orange |
118307 |
49735-0183-07 |
B4162 or B4157 |
Periflex Advance, chocolate |
118306 |
49735-0183-06 |
B4162 or B4157 |
Acerflex |
118842 |
49735-01-8842 |
B4162 or B4157 |
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Phlexy-10 System |
Bars |
10077 |
49735-0100-77 |
A9270 |
Drink Mix (Blackcurrant/Apple) |
11467 |
49735-0114-67 |
B4155 |
Drink Mix (Tropical Surprise) |
11910 |
49735-0119-10 |
B4155 |
Capsules |
11809 |
49735-0118-09 |
A9270 |
Tablets |
11951 |
49735-0119-51 |
A9270 |
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Other Metabolics |
Add-Ins |
12641 |
49735-0126-41 |
B4155 |
MSUD Aid |
10143 |
49735-0101-43 |
N/A |
Methionaid |
10242 |
49735-0102-42 |
N/A |
XMet, XCys Analog |
11653 |
N/A |
N/A |
XMet, XCys Maxamaid |
11457-1 |
N/A |
N/A |
Lanaflex |
12643 |
49735-0126-43 |
B4157 |
Milupa PKU 2 |
659346 |
81361-0934-60 |
B4155 |
Milupa PKU 3 |
659347 |
81361-0934-70 |
B4155 |
Milupa HOM 2 |
659357 |
81361-0935-70 |
B4155 |
Milupa MSUD 2 |
659351 |
81361-0935-10 |
B4155 |
Milupa OS 2 |
659349 |
81361-0934-90 |
B4155 |
Milupa UCD 2 |
659361 |
81361-0936-10 |
B4155 |
Neurology |
Product |
Nutricia Item |
Reimbursement |
HCPCS Code |
Ketocal 4:1 |
16670 |
49735-0166-70 |
B4154 |
Ketocal 3:1 |
16672 |
49735-0166-72 |
B4154 |
Ketocal 4:1 Liquid |
118796 |
49735-0187-96 |
B4154 |
Other
Nutritionals |
Product |
Nutricia Item |
Reimbursement |
HCPCS Code |
Monogen |
667097 |
49735-0170-97 |
B4150 or B4158 |
Super Soluble Duocal |
118262 (can) |
49735-0182-62 |
B4155 |
Super Soluble Duocal |
10281 (sachet) |
49735-0102-81 |
B4155 |
Complete Amino Acid Module |
10124-1 |
49735-0101-24 |
B4155 |
Essential Amino Acid Module |
11490-1 |
49735-0114-90 |
B4155 |
Phlexy-Vits |
10685 |
49735-0106-85 |
A9270 |
Flavor Packets |
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Cherry Vanilla |
10249 |
49735-0102-49 |
N/A |
Grapefruit |
10133 |
49735-0101-33 |
N/A |
Lemon-Lime |
10158 |
49735-0101-58 |
N/A |
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Low
Protein Products |
Loprofin |
Product |
Nutricia Item |
Reimbursement |
HCPCS Code |
Loprofin Baking Mix |
112658 |
49735-0151-45 |
S9434 or S9435* |
Wel-Plan Baking Mix |
105175 |
49735-0150-16 |
S9434 or S9435* |
Loprofin Cake Mix Chocolate |
113089 |
49735-0130-89 |
S9434 or S9435* |
Loprofin Spaghetti |
112310 |
49735-0150-15 |
S9434 or S9435* |
Loprofin Penne |
112298 |
49735-0150-25 |
S9434 or S9435* |
Loprofin Spirals |
112292 |
49735-0150-35 |
S9434 or S9435* |
Loprofin Tagliatelle |
112304 |
49735-0123-04 |
S9434 or S9435* |
Loprofin Animal Pasta |
114155 |
49735-0141-55 |
S9434 or S9435* |
Loprofin Elbow Pasta |
112296 |
49735-0122-96 |
S9434 or S9435* |
Loprofin Vermicelli |
112306 |
49735-0150-45 |
S9434 or S9435* |
Loprofin Lasagne |
112308 |
49735-0150-55 |
S9434 or S9435* |
Loprofin Rice |
112302 |
49735-0123-02 |
S9434 or S9435* |
Crackers |
112660 |
49735-0150-85 |
S9434 or S9435* |
Cereal loops |
112656 |
49735-0151-35 |
S9434 or S9435* |
Milupa |
Product |
Nutricia Item |
Reimbursement |
HCPCS Code |
lp-drink |
659916 |
49735-0152-34 |
S9434 or S9435* |
lp-fruity pear cereal mix |
659920 |
49735-0152-44 |
S9434 or S9435* |
lp-fruity apple-banana cereal mix |
659919 |
49735-0152-54 |
S9434 or S9435* |
lp-flakes |
309403 |
49735-0151-94 |
S9434 or S9435* |
lp-ringlets chocolate |
309471 |
49735-0152-04 |
S9434 or S9435* |
lp-chips paprika |
309406 |
49735-0152-14 |
S9434 or S9435* |
lp-bar fruits of the forest |
309481 |
49735-0151-74 |
S9434 or S9435* |
lp-bar apple-cinnamon |
309116 |
49735-0151-84 |
S9434 or S9435* |
* Some private insurers accept these codes. |
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