What insurance policy changes affect HCPCS B4164?

There are 6 tracked policy changes affecting HCPCS B4164, including updates from Anthem BCBS, CareSource. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS B4164?

Payers that have issued tracked updates for HCPCS B4164 include: Anthem BCBS, CareSource.

How do I get notified when HCPCS B4164 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS B4164. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS B4164?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

B4164 — Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix: Insurance Policy Changes

B4164 Insurance Policy Changes

HCPCS B4164 is officially defined as "Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix." HCPCS B4164 is referenced in 6 tracked payer policy changes from Anthem BCBS and CareSource. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS B4164 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listed

Anthem BCBS·Effective Jul 1, 2026

Effective July 1, 2026, Anthem will require prior authorization for 20 parenteral nutrition HCPCS codes (B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4187, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200) for Medicare Advantage members in Virginia. Prior authorization will be based on CMS LCD L38953 criteria, requiring documentation of a permanently nonfunctioning gastrointestinal tract. Claims submitted without prior authorization or that fail to meet medical necessity criteria will be denied.

B4164 Insurance Policy Changes

[New York] Precertification/prior authorization change to the parenteral nutrition codes listed

[Ohio] Requirements for Including National Drug Code

[California] Precertification/prior authorization change to the parenteral nutrition codes listed

[Ohio] Precertification/prior authorization change to the parenteral nutrition codes listed

[Virginia] Precertification/prior authorization change to the parenteral nutrition codes listed

[Georgia] Precertification/prior authorization change to the parenteral nutrition codes listed