Ordering & Reimbursement Information
Product Number
|
Description
|
Packaging
|
Reimbursement Code
|
HCPCS Code
|
52278
|
S.O.S. 20
|
30 x 42g packets
|
50600-0522-78
|
B4157 & B4162
|
52285
|
S.O.S. 25
|
30 x 52g packets
|
50600-0522-85
|
B4157 & B4162
|
WIC-Eligible Medical Food