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Updates to the List of Enteral Nutrition Products and Policy Reminders

July 30, 2019

Effective for dates of service on or after August 1, 2019, new billing codes for PediaSure products by Abbott Nutrition in the elemental and standard categories are reimbursable. These are additional billing codes to currently contracted products. The updated List of Enteral Nutrition Products will be released in a future Medi-Cal Update.

Newly added Abbott Nutrition Enteral Nutrition product billing codes
Product Label Name Medi-Cal Billing Number
PediaSure Peptide 1.0 Cal   1000ml RTH
Unflavored
70074067416
PediaSure Peptide 1.0 Cal   237ml
Vanilla Bottle
70074067410
PediaSure Peptide 1.0 Cal   237ml
Strawberry Bottle
70074067412
PediaSure Peptide 1.0 Cal   237ml
Unflavored Bottle
70074067414
PediaSure Peptide 1.5 Cal   1000ml RTH
Vanilla
70074067420
PediaSure Peptide 1.5 Cal   237ml
Vanilla Bottle
70074067418
PediaSure Grow & Gain with Fiber, vanilla, 237ml Can 70074067530
PediaSure 1.5 Cal with Fiber, vanilla, 1000ml RTH 70074067377
PediaSure 1.5 Cal with Fiber, vanilla, 237ml Can 70074067375
PediaSure 1.5 Cal, vanilla, 237ml Can 70074067386
PediaSure Enteral 1.0 Cal with Fiber, vanilla, 1000ml RTH 70074067406
PediaSure Enteral 1.0 Cal with Fiber, vanilla, 237ml Can 70074067404
PediaSure Enteral 1.0 Cal, vanilla, 237ml Can 70074067402
PediaSure Grow & Gain with Fiber, vanilla, 237ml Bottle 70074067532
PediaSure Gain & Grow, banana, 237ml Can 70074067528
PediaSure Grow & Gain, chocolate, 237ml Bottle 70074067536
PediaSure Grow & Gain, chocolate, 237ml Can 70074067524
PediaSure Grow & Gain, strawberry, 237ml Bottle 70074067538
PediaSure Grow & Gain, strawberry, 237ml Can 70074067526
PediaSure Grow & Gain, vanilla, 237ml Bottle 70074067534
PediaSure Grow & Gain, vanilla, 237ml Can 70074067185