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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · NephrologyMedium impact

Intradialytic Parenteral Nutrition

Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Intradialytic parenteral nutrition as an adjunct to hemodialysis may be considered medically necessary only when it is offered as an alternative to a regularly scheduled regimen of total parenteral nutrition (TPN), and only for individuals who would be candidates for TPN. It is considered investigational when it is given in addition to regularly scheduled TPN infusions, or for individuals who would not otherwise be candidates for TPN. The policy addresses only intravenous parenteral nutrition during hemodialysis, not peritoneal dialysis. The most recent entry in the policy history, dated 07/01/2026, states the policy statements are unchanged.

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What to do

Action · 5 steps
01Billing team: Bill the covered parenteral nutrition HCPCS codes only when the service is performed according to the policy section, which means it is offered as an alternative to a regularly scheduled regimen of TPN for individuals who are TPN candidates.
02Intradialytic parenteral nutrition given in addition to regularly scheduled TPN, or for individuals who would not otherwise be candidates for TPN, is considered investigational, and the policy defines investigational as not considered medically necessary.
03Check the member's specific benefit plan language before billing, because the Medical Policy Manual coverage guidelines should not be used in place of it.
04The source states the payer makes no payment for services not documented to be medically necessary.
05The investigational code listed in the source is HCPCS B4105, In-line cartridge containing digestive enzyme(s) for enteral feeding, each.

Codes mentioned

B4105B4164B4168B4172B4176B4178B4180B4185B4189B4193B4197B4199B4216B4220B4222B4224B5000B5100B5200

Original notice

Intradialytic Parenteral Nutrition
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Parenteral (PEN) and Enteral (EN) Nutrition Support in the HomeMediumEffective Oct 1, 2026 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesNephrologyCode B4105Code B4164Code B4168Code B4172Code B4176Code B4178Code B4180Code B4185Code B4189Code B4193Code B4197Code B4199Code B4216Code B4220Code B4222Code B4224Code B5000Code B5100Code B5200

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