Billing Information

Liquid Hope
(ADULT FORMULA)
  • HCPCS Code: B4149
  • Insurance Data Bank & Billing Code:
    57858-0004-11*
  • SID#: 201306012001, 20200224001
  • Product: LHWS124
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Liquid Hope Peptide
ADULT FORMULA
  • HCPCS Code: B4153
  • Insurance Data Bank & Billing Code:
    57858-0004-28*
  • SID#: 20130612001
  • Product: LHPWS124
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Liquid Hope Peptide High Protein
ADULT FORMULA
  • HCPCS Code: B4153
  • Insurance Data Bank & Billing Code:
    57858-0004-32
  • SID#: 20161118001
  • Product: LHHPWS124
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Nourish
PEDIATRIC FORMULA
  • HCPCS Code: B4149
  • Insurance Data Bank & Billing Code:
    57858-0004-12*
  • SID#: 20161118001, 20200224001
  • Product: NWS124
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Nourish Peptide
PEDIATRIC FORMULA
  • HCPCS Code: B4161
  • Insurance Data Bank & Billing Code:
    57858-0004-27*
  • SID#: 20161118001
  • Product: NOUPWS124
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Nourish Peptide Berry Medley
PEDIATRIC FORMULA
  • HCPCS Code: B4161
  • Insurance Data Bank & Billing Code:
    57858-0004-44
  • SID#: 20161118001
  • Product: NOUPBWS124
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Keto
Ketogenic Formula
  • HCPCS Code: B4153, B4161
  • Insurance Data Bank & Billing Code:
    57858-0004-24*
  • SID#: 20200131002
  • Product: KEWS124
More Info

*Medicare, Medicaid and health insurers may ask you to provide a National Drug Code / NDC number for insurance claims, billing or reimbursement purposes. Because our products are whole foods and do not constitute “drugs”, we have an Insurance Data Bank and Billing Code that you should use when asked for an NDC number for our products.

We Can Help

At Functional Formularies we have patient advocates available to help assist you in gaining insurance
coverage for our products. Please fill out the form or call us at 937-433-4673
and we will set up an appointment for you with a patient advocate.
We Can Help
Do you have a current home health company?
Do you have health insurance?
Have you received a denial from your insurance?

Billing Information

Liquid Hope
HCPCS Code: B4149
Nourish
HCPCS Code: B4149
Liquid Hope
Peptide & High Protein
HCPCS Code: B4153
Nourish
Peptide & Berry Medley
HCPCS Code: B4161
Keto
Peptide
HCPCS Code: B4161 & B4153

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