SHS North America
Home About Us Products Ordering What's New ResourcesHealthcare Providers Contact Us
 
Pediatric GI/Allergy Metabolics Neurology Other Nutritionals Low Protein Products

Product Reimbursement 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 One+ Powder

11048

49735-0110-48

B4161

Neocate Junior (Unflavored)

11790-USA

49735-0117-90

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

return to top


Metabolics

 

Analog Range

Product

Code

Code

HCPCS Code

XPhe Analog, now Periflex Infant

11880

49735-0118-80

B4162

MSUD Analog

11886

49735-0118-86

B4162

XPhe, XTyr Analog

11885

49735-0118-85

B4162

XPTM Analog

11884

49735-0118-84

B4162

XMTVI Analog

11887

49735-0118-87

B4162

XMet Analog

11881

49735-0118-81

B4162

XLys, XTrp Analog

11882

49735-0118-82

B4162

XLeu Analog

11888

49735-0118-88

B4162

 

 

 

 

Maxamaid Range

XPhe Maxamaid, orange

12357

49735-0123-57

B4162

XPhe Maxamaid, unflavored

12358

49735-0123-58

B4162

XPhe Maxamaid, strawberry

12371

49735-0123-71

B4162

MSUD Maxamaid

12360

49735-0123-60

B4162

XPhe, XTyr Maxamaid

12362

49735-0123-62

B4162

XMTVI Maxamaid

12361

49735-0123-61

B4162

XMet Maxamaid

12363

49735-0123-63

B4162

XLys, XTrp Maxamaid

12359

49735-0123-59

B4162

XLeu Maxamaid

12364

49735-0123-64

B4162

 

 

 

 

Maxamum Range

XPhe Maxamum, orange (cans)

12302

49735-0123-02

B4157 or B4162

XPhe Maxamum, unflavored (cans)

12301

49735-0123-01

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

12340

49735-0123-40

B4157 or B4162

XMTVI Maxamum

12342

49735-0123-42

B4157 or B4162

XMet Maxamum

12341

49735-0123-41

B4157 or B4162

XLys,XTrp Maxamum

12344

49735-0123-44

B4157 or B4162

XLeu Maxamum

12343

49735-0123-43

B4157 or B4162

 

 

 

 

 Lophlex

Lophlex, Berry

12169

49735-0121-69

B4155

Lophlex, Orange

12167

49735-0121-67

B4155

 

 

 

 

Periflex/Acerflex

Periflex Infant, formerly XPhe Analog

11880

49735-0118-80

B4162

Periflex Junior, unflavored

11402

49735-0114-02

B4162 or B4157

Periflex Junior, orange

11401

49735-0114-01

B4162 or B4157

Periflex Junior, chocolate

12531

49735-0125-31

B4162 or B4157

Periflex Advance, unflavored

12650

49735-0126-50

B4162

Periflex Advance, orange

12652

49735-0126-52

B4162

Periflex Advance, chocolate

12651

49735-0126-51

B4162

Acerflex

10026

49735-0100-26

B4162

 

 

 

 

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

Add-Ins

11810

49735-0118-10

B4155

 

 

 

 

Other Metabolics

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 Tomato

309087 - Case

81361-9087-01

B4162 or B4157

Milupa PKU 2

659346

81361-9346-01

B4155

Milupa PKU 3

659347

81361-9347-01

B4155

Milupa HOM 2

659357

81361-9357-01

B4155

Milupa MSUD 2

659351

81361-9351-01

B4155

Milupa OS 2

659349

81361-9349-01

B4155

Milupa TYR 2

659353

81361-9353-01

B4155

Milupa UCD 2

659361

81361-9361-01

B4155

return to top


Neurology

 

Product

Nutricia Item

Reimbursement

HCPCS Code

Ketocal 4:1

16670

49735-0166-70

B4154

Ketocal 3:1

16672

49735-0166-72

B4154

return to top


Other Nutritionals

 

Product

Nutricia Item

Reimbursement

HCPCS Code

Monogen

667097

49735-0170-97

B4150 or B4158

Super Soluble Duocal

10280

49735-0102-80

B4155

Polycal

21152

49735-0111-52

B4155

Protifar

21134

49735-0111-34

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

return to top


Low Protein Products

 

Loprofin

Product

Nutricia Item

Reimbursement

HCPCS Code

Drink Mix

L512

49735-0151-25

S9434 or S9435*

Cereal Loops

L513

49735-0151-35

S9434 or S9435*

Spaghetti

L501

49735-0150-15

S9434 or S9435*

Macaroni Penne

L502

49735-0150-25

S9434 or S9435*

Spirals

L503

49735-0150-35

S9434 or S9435*

Vermicelli

L504

49735-0150-45

S9434 or S9435*

Lasagne

L505

49735-0150-55

S9434 or S9435*

Sweet Biscuits (Cookies)

L506

49735-0150-65

S9434 or S9435*

Chocolate Cream Biscuits

L507

49735-0150-75

S9434 or S9435*

Crackers

L508

49735-0150-85

S9434 or S9435*

Vanilla Cream Wafers

L509

49735-0150-95

S9434 or S9435*

Chocolate Cream Wafers

L510

49735-0151-05

S9434 or S9435*

Orange Cream Wafers

L511

49735-0151-15

S9434 or S9435*

Baking Mix

L514

49735-0151-45

S9434 or S9435*

 

 

 

 

Wel-Plan

Baking Mix

WP501

49735-0150-16

S9434 or S9435*

 

 

 

 

Milupa

Product

Nutricia Item

Reimbursement

HCPCS Code

lp-drink

LC523

49735-0152-34

S9434 or S9435*

lp-drink chocolate

L515

49735-0151-54

S9434 or S9435*

lp-fruity pear cereal mix

LC524

49735-0152-44

S9434 or S9435*

lp-fruity apple-banana cereal mix

L525

49735-0152-54

S9434 or S9435*

lp-flakes

L519

49735-0151-94

S9434 or S9435*

lp-ringlets chocolate

L520

49735-0152-04

S9434 or S9435*

lp-chips paprika

L521

49735-0152-14

S9434 or S9435*

lp-snack italian

L522

49735-0152-24

S9434 or S9435*

lp-bar apricot

L516

49735-0151-64

S9434 or S9435*

lp-bar fruits of the forest

L517

49735-0151-74

S9434 or S9435*

lp-bar apple-cinnamon

L518

49735-0151-84

S9434 or S9435*

 

 

 

 

* Some private insurers accept these codes.

return to top