Ordering & Reimbursement Information
|
Product
|
Packaging
|
Product Number
|
Reimbursement Code
|
HCPCS Code
|
|
PKU sphere15 Vanilla
|
30 x 27g
|
21438
|
50600-0214-38
|
B4162 & B4157
|
|
PKU sphere15
Red Berry
|
30 x 27g
|
21131
|
50600-0211-31
|
B4162 & B4157
|
|
PKU sphere20 Vanilla
|
30 x 35g
|
21124
|
50600-0211-24
|
B4162 & B4157
|
|
PKU sphere20
Red Berry
|
30 x 35g
|
21117
|
50600-0211-17
|
B4162 & B4157
|
|
PKU sphere20
Chocolate
|
30 x 35g
|
22053
|
50600-0220-53
|
B4162 & B4157
|