B4178: Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix
B4178 is a HCPCS Level II code for parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix. It belongs to the Enteral and Parenteral Therapy section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits: units per day
The most units of B4178 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0, never payable MAI 3: Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0, never payable MAI 3: Date of Service Edit: Clinical · CMS Policy
- DME supplier
- 2 units MAI 1: Line Edit · Clinical: Data
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute, no documentation overrides it. CMS MUE 2026Q4.
The CMS record for B4178
- Long descriptor
- Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix
- Short descriptor
- Parenteral sol amino acid >
- Added
- January 1, 1988
- BETOS
- O1C
- Pricing indicator
- 39: DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service: CMS's own analytic grouping.
Parenteral and enteral nutrition.
Codes adjacent to B4178
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If B4178 is not quite right, the correct code is very often within a few positions of it.
- B4159Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit
- B4160Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
- B4161Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
- B4162Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
- B4164Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix
- B4168Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix
- B4172Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix
- B4176Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix
- B4180Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix
- B4185Parenteral nutrition solution, not otherwise specified, 10 grams lipids
- B4187Omegaven, 10 grams lipids
- B4189Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix
- B4193Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix
- B4197Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix
- B4199Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix
- B4216Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day