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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.

For additional information, please call our Nutrition Information Department

United States:
(800) 365-7354

Canada:
(877) 636-2283

 

HCPCS codes

Pediatric GI/Allergy Metabolics Neurology Other Nutritionals Low Protein Products

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

 


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

 

 

 

 

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

 

 

 

 

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

 

 

 

 

 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

 

 

 

 

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

 

 

 

 

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

 

 

 

 

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

 

 

 

     Cherry Vanilla

10249

49735-0102-49

N/A

     Grapefruit

10133

49735-0101-33

N/A

     Lemon-Lime

10158

49735-0101-58

N/A

 

 

 

 


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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