Read Reimbursement Code Cross-Reference 6.16.xlsx text version

PRODUCTS UNDERGOING CHANGES BETWEEN JULY 1- OCT 1, 2011

(Any changes to name or codes are noted in red, otherwise information remains the same. )

First Data Bank NDC Format Number*

Product and SKU Description IMPACT® Peptide 1.5 Formula- New Product 24 x 250 fl oz Closed System Containers with SpikeRight® port 6 x 1000 mL NEW

UPC Item 043900973999

UPC Case 10043900974009

NDC Format Number 43900097399

Product Code 4390097400

HCPCS Code

043900973708 10043900973712 NOVASOURCE® RENAL Nutritionally Complete Formula - Reformulation, Same Name 27 x 8 fl oz 043900351117 10043900351107 Closed System Containers with SpikeRight® port 6 x 1000 mL 043900351803 10043900351800 Former 27 x 8 fl oz 043900351117 10043900351107 Closed System Containers with SpikeRight® port 6 x 1000 mL 043900351803 10043900351800 NEW RESOURCE ARGINAID® Drink Mix - Name Change to: ARGINAID® Drink Mix Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 Lemon 56 x 0.32 oz (9 g) pkts 043900359823 10043900359851 Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 Former Orange 56 x 0.32 oz (9 g) pkts 043900359809 10043900359837 Lemon 56 x 0.32 oz (9 g) pkts 043900359823 10043900359851 Cherry 56 x 0.32 oz (9 g) pkts 043900359885 10043900359844 NEW RESOURCE ® BENECALORIE® - Name Change to: BENECALORIE® Former NEW 24- 1.5 oz cups/case 24- 1.5 oz cups/case 043900282503 043900282503 10043900282500 10043900282500

43900097370 00212351162

4390097371 35110000

B4153

00212351814 00212351162

43900035180

35180100 35110000

B4154

00212351814

43900035180

35180100

B4154

00212598375 00212598575 00212598475 00212598375 00212598575 00212598475

35983000 35985000 35984000 35983000 35985000 35984000

B4155

B4155

00212282580 00212282580

28250000 28250000

B4155 B4155

RESOURCE® BENEFIBER® Soluble Dietary Fiber - Name Change to: NUTRISOURCE FIBER Powder 75 x 4 g (0.141 oz) pkts 043900282305 10043900282302 00212282374 Powder 4 x 7.2 oz (205 g) Canister 043900282107 10043900282104 00212282107 Former Powder 75 x 4 g (0.141 oz) pkts 043900976471 10043900976485 43900097647 Powder 4 x 7.2 oz (205 g) Canister 043900975504 10043900975518 43900097550 NEW RESOURCE® BENEPROTEIN® Instant Protein Powder - Name Change to: BENEPROTEIN® Instant Protein Powder Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 Powder 6 x 8 oz 043900284101 10043900284108 00212284107 Former Powder 75 x 7 g (0.25 oz) pkts 043900284309 10043900284306 00212284371 Powder 6 x 8 oz 043900284101 10043900284108 00212284107 NEW RESOURCE® GLUTASOLVE® Glutamine Intensive Powder - Name Change GLUTASOLVE® Glutamine Intensive Powder 56 x 22.5 g (0.79 oz) Former pkts 043900283005 10043900283309 00212283378 56 x 22.5 g (0.79 oz) NEW pkts 043900283005 10043900283309 00212283378 TOLEREX® Elemental Formula - Change to Nutrition Information on Label only Former NEW 60 x 2.82 oz (80 g) pkts 043900458069 60 x 2.82 oz (80 g) pkts 043900458069 10043900458059 10043900458059 00212458072 00212458072

28230000 28210000 4390097648 4390097551

B4104

B4104

28430000 28410000 28430000 28410000

B4155

B4155

28330000 28330000

B4155 B4155

04580500 04580500

B4153 B4153

VIVONEX ® PEDIATRIC Elemental Formula - Change to Nutrition Information on Label only Former NEW 36 x 48.5 g (1.7 oz) pkts 043900713199 36 x 48.5 g (1.7 oz) pkts 043900713199 10043900713103 10043900713103 00212713176 00212713176 00212729818 07131000 07131000 07129800

B4161 B4161 B4153

VIVONEX ® PLUS Elemental Formula - Change to Nutrition Information on Label only Former 36 x 2.8 oz (79 g) pkts 043900712994 10043900712984

NEW

36 x 2.8 oz (79 g) pkts

043900712994

10043900712984

00212729818

07129800

B4153

VIVONEX ® T.E.N. Elemental Formula - Change to Nutrition Information on Label only 60 x 80.4 g (2.84 oz) Former pkts 043900712741 10043900712748 60 x 80.4 g (2.84 oz) NEW pkts 043900712741 10043900712748

Benefiber is the registered trademark of Novartis AG and is used under license.

®

00212727873 00212727873

07127400 07127400

B4153 B4153

* First Data Bank NDC Format Number - Since Nestlé no longer prints NDC Format Codes on product labels, FDB uses the product UPC code to create a number that can be found in the "NDC" field of the FDB publication.

Reimbursement information provided by Nestlé HealthCare Nutrition, Inc., (HCN) is gathered from third party sources and is presented for illustrative purposes only. This information does not constitute reimbursement or legal advice and does not constitute a recommendation related to medical necessity or the documentation that should be provided in connection with a given patient or claim. All medical necessity determinations must be made by the responsible clinician. HCN makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability to a particular patient. HCN specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Suppliers are responsible for submitting accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. Accordingly, HCN recommends that you consult with your payers, reimbursement specialist and/or legal counsel regarding coding, coverage and reimbursement matters.

Except as noted all trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland. 6.16.11 FINAL

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Reimbursement Code Cross-Reference 6.16.xlsx