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Nestlé HealthCare Nutrition Enteral Products

Product Product Code NDC Formatted Number HCPCS Code kCal/ mL* Container Size (mL or g) kCal/ Container† Pack Factor/ Cs kCal/Cs 100 kCal Units/Case

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Text of Nestlé HealthCare Nutrition Enteral Products

ProductProduct CodeNDC Formatted NumberHCPCS CodekCal/ mL*Container Size (mL or g)kCal/Container Pack Factor/ CskCal/Cs100 kCal Units/CaseARGINAID , Orange, oz pkts - New Name, Replaces RESOURCE ARGINAID , Cherry, oz pkts - New Name, Replaces RESOURCE ARGINAID , Lemon, oz , fl oz cups - New Name, Replaces RESOURCE BENECALORIE , 7 g pkts - New Name, Replaces RESOURCE BENEPROTEIN 2843000000212284371B4155 7 , 8 oz canister - New Name, Replaces RESOURCE BENEPROTEIN 2841000000212284107B4155 227 , Very Vanilla, 8 fl , Rich Chocolate, 8 fl , Creamy Strawberry, 8 fl GLUCOSE CONTROL , Vanilla, 8 fl GLUCOSE CONTROL , Chocolate, 8 fl GLUCOSE CONTROL , Strawberry, 8 fl HIGH PROTEIN, Very Vanilla, 8 fl KID ESSENTIALS, Vanilla, 8 fl KID ESSENTIALS, Chocolate, 8 fl KID ESSENTIALS, Strawberry, 8 fl KID ESSENTIALS , Vanilla, 8 fl KID ESSENTIALS , Chocolate, 8 fl KID ESSENTIALS , Strawberry, 8 fl KID ESSENTIALS with FIBER, Vanilla, 8 fl PLUS , Very Vanilla, 8 fl PLUS , Rich Chocolate, 8 fl PLUS , Creamy Strawberry, 8 fl VHC, Vanilla, 8 fl oz - New Name, Replaces CARNATION INSTANT BREAKFAST LACTOSE FREE INSTANT BREAKFAST LACTOSE FREE, Vanilla Swirl, 250 mL INSTANT BREAKFAST LACTOSE FREE, Chocolate Splash, 250 mL INSTANT BREAKFAST LACTOSE FREE PLUS, Vanilla Swirl, 250 mL INSTANT BREAKFAST LACTOSE FREE PLUS, Chocolate Splash, 250 INSTANT BREAKFAST LACTOSE FREE VHC, Vanilla, 250 mL - Replaced by BOOST HealthCare Nutrition Enteral Products NUmber oF 100 kCaL UNitS Per CaSeProductProduct CodeNDC Formatted NumberHCPCS CodekCal/ mL*Container Size (mL or g)kCal/Container Pack Factor/ CskCal/Cs100 kCal Units/CaseCOMPLEAT , 250 , SpikeRight PLUS UltraPak , 1000 , SpikeRight PLUS UltraPak , 1500 PEDIATRIC, 250 PEDIATRIC REDUCED CALORIE, Unflavored, 250 , 250 , SpikeRight , 1000 AC, 250 AC, SpikeRight , 1000 AC, SpikeRight , 1500 HN, 250 HN, SpikeRight PLUS UltraPak , 1000 HN, SpikeRight PLUS UltraPak , 1500 , g pkts - New Name, Replaces RESOURCE GLUTASOLVE , 250 , SpikeRight , 1000 , 250 ADVANCED RECOVERY , Vanilla, 8 fl ADVANCED RECOVERY , Chocolate, 8 fl with FIBER, 250 mL with FIBER, SpikeRight , 1000 mL GLUTAMINE, 250 GLUTAMINE, SpikeRight PLUS UltraPak , 1000 PEPTIDE , 250 PEPTIDE , SpikeRight PLUS UltraPak , 1000 CAL, 250 CAL, SpikeRight , 1000 CAL, SpikeRight , 1500 HN, 250 HN, SpikeRight , 1000 HN, SpikeRight , 1500 Oil , 1 , 3 fl RENAL, 8 fl RENAL, SpikeRight , 1000 CodeNDC Formatted NumberHCPCS CodekCal/ mL*Container Size (mL or g)kCal/Container Pack Factor/ CskCal/Cs100 kCal Units/CaseNUTREN , Vanilla, 250 FIBER, Vanilla, 250 , Vanilla, 250 , SpikeRight PLUS UltraPak , 1000 , Vanilla, 250 , SpikeRight PLUS UltraPak , 1000 GLYTROL , Vanilla, 250 GLYTROL , UltraPak SpikeRight , 1000 GLYTROL , UltraPak SpikeRight , 1500 JUNIOR , Vanilla, 250 JUNIOR , SpikeRight PLUS UltraPak , 1000 JUNIOR FIBER, Vanilla, 250 JUNIOR FIBER, SpikeRight PLUS UltraPak , 1000 PULMONARY, Vanilla, 250 PULMONARY, SpikeRight PLUS UltraPak , 1000 REPLETE , Vanilla, 250 mL - See Replete REPLETE , UltraPak SpikeRight , 1000 mL - See Replete REPLETE FIBER, Vanilla, 250 mL - See Replete REPLETE FIBER, UltraPak SpikeRight , 1000 mL - See Replete REPLETE FIBER, UltraPak SpikeRight , 1500 mL - See Replete , Unflavored, 250 FIBER Powder, oz canister - New Name, Replaces RESOURCE BENEFIBER 439009755143900097550B4104 205 FIBER Powder, 4 g pkts - New Name, Replaces RESOURCE BENEFIBER 439009764843900097647B4104 4 , Unflavored, 250 , Vanilla, 250 , Unflavored, 250 , Vanilla, 250 , SpikeRight PLUS UltraPak , 1000 with PREBIO1TM, Vanilla, 250 with PREBIO1TM, SpikeRight PLUS UltraPak , 1000 AF , Unflavored, 250 AF , SpikeRight PLUS UltraPak , 1000 CodeNDC Formatted NumberHCPCS CodekCal/ mL*Container Size (mL or g)kCal/Container Pack Factor/ CskCal/Cs100 kCal Units/CasePEPTAMEN BARIATRIC, Unflavored, 250 BARIATRIC, SpikeRight PLUS UltraPak , 1000 with PREBIO1TM, Vanilla, 250 with PREBIO1TM, SpikeRight PLUS UltraPak , 1000 with PREBIO1TM SpikeRight PLUS UltraPak , 1500 JUNIOR , Unflavored, 250 JUNIOR , Vanilla, 250 JUNIOR , Chocolate, 250 JUNIOR , Strawberry, 250 JUNIOR , SpikeRight PLUS UltraPak , 1000 JUNIOR FIBER, Vanilla, 250 JUNIOR , Unflavored, 250 mL JUNIOR , SpikeRight PLUS UltraPak , 1000 JUNIOR with PREBIO1TM, Vanilla, 250 mL , Unflavored, 250 , Vanilla, 250 mL - New Name, Replaces NUTREN REPLETE , SpikeRight PLUS UltraPak , 1000 mL - New Name, Replaces NUTREN REPLETE FIBER, Vanilla, 250 mL - New Name, Replaces NUTREN REPLETE FIBER, SpikeRight PLUS UltraPak , 1000 mL - New Name, Replaces NUTREN REPLETE FIBER, SpikeRight PLUS UltraPak , 1500 mL - New Name, Replaces NUTREN REPLETE , Vanilla Cr me, 32 fl oz , Vanilla Cr me, 8 fl oz ARGINAID , Orange, oz pkts - See ARGINAID ARGINAID , Cherry, oz pkts - See ARGINAID ARGINAID , Lemon, oz pkts - See ARGINAID ARGINAID EXTRA , Orange Burst, 8 fl ARGINAID EXTRA , Wildberry, 8 fl BENECALORIE , fl oz cups - See BENECALORIE BENEFIBER Powder, 4 g pkts - See NUTRISOURCE FIBER2823000000212282374B4104 4 BENEFIBER Powder, oz canister - See NUTRISOURCE FIBER2821000000212282107B4104 205 CodeNDC Formatted NumberHCPCS CodekCal/ mL*Container Size (mL or g)kCal/Container Pack Factor/ CskCal/Cs100 kCal Units/CaseRESOURCE BENEPROTEIN , 7 g pkts - See BENEPROTEIN 2843000000212284371B4155 7 BENEPROTEIN , 8 oz canister - See BENEPROTEIN 2841000000212284107B4155 227 BREEZE, Orange, 8 fl oz1862000000212186262B4154 BREEZE, Peach, 8 fl oz1864000000212186462B4154 BREEZE, Wild Berry, 8 fl oz1866000000212186662B4154 BREEZE, Variety Case, 8 fl oz1860000000212186062B4154 DIABETISHIELD , Orange Twist, 8 fl oz3491000000212349162B4154|| DIABETISHIELD , Mixed Berry, 8 fl oz3493000000212349362B4154|| GLUTASOLVE , g pkts - See GLUTASOLVE , oz PEDIATRIC, oz PLUS, oz RTF, 250 RTF, SpikeRight PLUS UltraPak , 1000 RTF, SpikeRight PLUS UltraPak , 1500 , oz 1/1/2012* kCal/mL is a rounded number and should not be used for the purpose of calculating number of calories/case. Rely on the label declaration for calculating calories/container. kCal/Container is based on the label declaration for the product. This is the value that should be used as the basis for calculations. BENEFIBER is the registered trademark of Novartis AG and is used under license. RESOURCE BREEZE - HCPCS code formerly B4102 and B4103|| RESOURCE DIABETISHIELD - HCPCS code formerly B4102Note: Italicized products to be discontinued in 2011/2012The reimbursement information contained in this publication is gathered from third party sources and is presented for illustrative purposes only. This information should not be interpreted as a guarantee of reimbursement or as endorsed by Medicare, Medicaid, or an Insurance Carrier. Billing entities should contact their third-party payers for specific information on their coding, coverage and payment policies. While this publication provides examples of clinical information that may be pertinent in seeking enteral coverage for a beneficiary, it does not constitute a recommendation related to a medical necessity determination 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(s). In addition, the actual documentation used to support a given claim must be true in all respects and accurately represent the individual beneficiary s condition and circumstances. The person or entity submitting claims for reimbursement is solely responsible for ensuring the appropriate filing and accurate content of any particular claim. Persons who submit false or fraudulent claims for reimbursement are subject to significant civil and criminal be advised that certain Nestl HealthCare Nutrition products have been assigned NDC Formatted Numbers. NDC Formatted Numbers are not actual National Drug Codes (NDC). NDC Formatted Numbers are product codes adjusted according to standard industry practice to meet the format requirements of certain suppliers and payers. Nestl HealthCare Nutrition submits product information including various product codes to the compendia including First Data Bank, RedBook and Medispan but cannot confirm that the NDC Formatted Numbers submitted have been published by the 1-800-422-ASK2 (2752)Florham Park, NJ 07932-1521 USAUnless otherwise noted, all trademarks are owned by Soci t des Produits Nestl , Vevey, Switzerland or used with permission. 2012 Nestl HCN 315-11

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