Insurance Billing Codes

The following information is provided to assist you with obtaining insurance reimbursement for our products. Individual coverage varies by state and provider. Please contact your provider for more information.

PHENYLKETONURIA (PKU)
PKU Gel Unflavored	1 year to 10 years	Powder	30x24g		50600-0514-48	B4162
PKU Gel Orange					50600-0514-62	B4162
PKU Gel Raspberry					50600-0514-55	B4162
PKU Express Unflavored	8 years and older	Powder	30x25g		50600-0532-06	B4162
PKU Express Orange					50600-0532-20	B4162
PKU Express Lemon					50600-0533-05	B4162
PKU Express Tropical					50600-0533-36	B4162
PKU Cooler 10 Orange	3 years and older	RTF	30x87ml		50600-0548-52	B4162/B4157
PKU Cooler 10 Purple					50600-0548-76	B4162/B4157
PKU Cooler 10 White					50600-0549-99	B4162/B4157
PKU Cooler 15 Orange	8 years and older	RTF	30x130ml		50600-0545-00	B4162/B4157
PKU Cooler 15 Purple					50600-0545-62	B4162/B4157
PKU Cooler 15 White					50600-0549-75	B4162/B4157
PKU Cooler 20 Orange	8 years and older	RTF	30x174ml		50600-0548-14	B4162/B4157
PKU Cooler 20 Purple					50600-0548-38	B4162/B4157
PKU Cooler 20 White					50600-0550-19	B4162/B4157

MAPLE SYRUP URINE DISEASE (MSUD)
MSUD Gel Unflavored	1 year to 10 years	Powder	30x24g		50600-0514-93	B4162
MSUD Express Unflavored	8 years and older	Powder	30x25g		50600-0535-34	B4155
MSUD Cooler	3years and older	RTF	30x130ml		50600-0546-54	B4162/B4157

TYROSINEMIA
TYR Gel Unflavored	1 year to 10 years	Powder	30x24g		50600-0515-09	B4162
TYR Express Unflavored	8 years and older	Powder	30x25g		50600-0538-48	B4155
TYR Cooler	3 years and older	RTF	30x130ml		50600-0539-92	B4162/B4157

HOMOCYSTINURIA
HCU Gel Unflavored	1 year to 10 years	Powder	30x24g		50600-0514-86	B4162
HCU Express Unflavored	8 years and older	Powder	30x25g		50600-0535-58	B4155
HCU Cooler	3 years and older	RTF	30x130ml		50600-0535-27	B4162/B4157

MMA/PA
MMA Gel Unflavored	1 year to 10 years	Powder	30x24g		50600-0515-23	B4162
MMA Express Unflavored	8 years and older	Powder	30x25g		50600-0543-71	B4155

UREA CYCLE DISORDERS
EAA Supplement	3 years and older	Powder	50x12.5g		50600-0549-06	B4155

GLUTARIC ACIDURIA TYPE 1
GA gel	1 year to 10 years	Powder	30x24g		50600-0515-16	B4162

FAT MALABSORPTION
Lipistart	1 year and older	Powder	400g tin		50600-0502-05	B4158/B4150
MCT Pro-Cal	1 year and older	Powder	30x16g		50600-0502-36	B4162/B4157

NUTRIENT ENHANCEMENT
Pro-Cal (sachets)	1 year and older	Powder	30x15g		50600-0500-76	B4155
Pro-Cal (tub)	1 year and older	Powder	510g		50600-0500-07	B4155

AMINO ACID SUPPLEMENTS
Arginine Supplement	1 year and older	Powder	30x4g		50600-0546-92	B4155
Cystine Supplement					50600-0547-77	B4155
Citrulline 1000 Supplement					50600-0550-95	B4155
Isoleucine Supplement					50600-0543-02	B4155
Isoluecine 1000 Supplement					50600-0551-18	B4155
Leucine Supplement					50600-0549-20	B4155
Phenylalanine Supplement					50600-0549-44	B4155
Tyrosine Supplement					50600-0547-91	B4155
Valine Supplement					50600-0543-33	B4155
Valine 1000 Supplement					50600-0551-32	B4155

PEDIATRIC RENAL
Renastart	1 year and older	Powder	10x100g		50600-0551-56	B4154

FLAVOR PACS
Flavor Pac Lemon	1 year and older	Powder	30x4g	50600-0540-98		NA
Flavor Pac Orange				50600-0541-11		NA
Flavor Pac Raspberry				50600-0541-35		NA
Flavor Pac Black Currant				50600-0541-59		NA
Flavor Pac Tropical				50600-0541-73		NA

How to Order

How to Order