Infant Nutritionals
Enfamil® Newborn
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
146608
Powder
12.5 oz can
1800
90
6 cans per
case
N/A
00087-510050
146625
Powder
22.02 oz tub
3220
161
4 tubs per
case
B4158
00087-146645
146624
Powder
33.2 oz box
4820
241
4 boxes per
case
N/A
00087-510042
165701
RTU, 20 Cal
2 fl oz
bottles
40
2
48 bottles
per case
B4158
00087-165741
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
138501
Concentrate
8 fl oz bottle
320
16
4 bottles per
case
N/A
00087-510244
Enfamil® Infant
136701
Concentrate
13 fl oz can
520
26
12 cans per
case
B4158
00087-136741
136502
Powder
12.5 ox can
1800
90
6 cans per
case
B4158
00087-136542
136573
Powder
22.2 oz tub
3180
159
6 tubs per
case
B4158
00087-136560
136572
Powder
33.2 oz box
4740
237
4 boxes per
case
B4158
00087-136561
136527
Single-Serve
Powder
Packets
16 (17.6g)
stick packs
per carton
1408
70.4
6 cartons per
case
B4158
00087-136567
136601
RTU
6, 2 fl oz
bottles per
carton
240
12
8 cartons per
case
B4158
00087-136641
145801
RTU
6 fl oz bottle
960
48
24 bottles
per case
B4158
00087-145841
138401
RTU
8 fl oz bottle
160
8
24 bottles
per case
N/A
00087-510242
145901
RTU
8 fl oz cans
per carton
640
32
4 cartons per
case
B4158
00087-145941
Enfamil® Gentlease®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
869353
Powder
12.4 oz can
1800
90
6 cans per
case
B4158
N/A
8693C2
Powder
21.5 oz tub
3100
155
4 tubs per
case
N/A
00087-869376
8693C1
Powder
32.2 oz box
4640
232
4 boxes per
case
N/A
00087-869377
146401
RTU
2 fl oz bottle
40
2
48 bottles
per case
B4158
00087-146441
146501
RTU
32 fl oz can
640
32
6 cans per
case
N/A
00087-146541
869369
Single-Serve
Powder
Packets
14 (17.4g)
stick pks /
carton
1260
63
4 units per
case
N/A
N/A
Enfamil A.R.®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
020102
Powder
12.9 oz (366
g) can
1820
91
6 cans per
case
B4158
00087-020165
020136
Powder
21.5 oz tub
3040
152
4 tubs per
case
B4158
00087-020165
020135
Powder
32.2 oz box
4680
234
4 boxes per
case
N/A
00087-510096
145301
RTU
2 fl oz bottle
40
2
48 bottles
per case
B4158
00087-145341
153401
RTU
8 fl oz bottle
160
8
24 bottles
per case
N/A
00087-510000
020333
RTU
32 fl oz can
640
32
6 cans per
case
B4158
00087-020373
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
149901
Concentrate
8 fl oz bottle
320
16
24 bottles
per case
N/A
00087-510252
119501
Concentrate
13 fl oz can
520
26
12 cans per
case
B4159
00087-119541
121401
Powder
12.9 oz can
1840
92
6 cans per
case
B4159
00087-121441
121460
Powder
22 oz can
3180
159
4 cans per
case
B4159
00087-121424
144901
RTU
2 fl oz bottle
40
2
48 bottles
per case
B4159
00087-144941
026106
RTU
6 fl oz bottle
120
6
24 bottles
per case
B4159
00087-026124
149801
RTU
8 fl oz bottle
160
8
24 bottles
per case
N/A
00087-510250
030934
RTU
32 fl oz can
640
32
6 cans per
case
B4159
00087-030974
Enfamil® ProSobee®
Nutramigen® with Enflora™ LGG®*
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
123901
Powder
12.6 oz can
(357 g)
1740
87
6 cans per
case
B4161
00087-123941
123905
Powder
19.8 oz can
(561 g)
2780
139
4 cans per
case
N/A
N/A
*LGG is a registered trademark of Valio Ltd.
Enfamil® Premature
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
139401
RTU, 20 Cal
Low Iron
2 fl oz bottle
40
2
48 bottles
per case
B4160
00087-139441
RTU, 20 Cal
2 fl oz bottle
Iron Fortified
40
2
48 bottles
per case
B4160
00087-139241
2 fl oz bottle
48
2
48 bottles
per case
B4160
00087-139141
139301
RTU, 24 Cal
2 fl oz bottle
Iron Fortified
48
2
48 bottles
per case
B4160
00087-139341
148101
RTU, 24 Cal
High Protein
2 fl oz bottle
48
2
48 bottles
per case
B4160
00087-148141
137601
RTU, 30 Cal
2 fl oz bottle
60
2
48 bottles
per case
N/A
N/A
139201
139101
RTU, 24 Cal
Low Iron
Nutramigen® (Liquids)
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
148601
Concentrate
8 fl oz bottle
320
16
24 bottles
per case
N/A
00087-510248
049811
Concentrate
13 fl oz can
520
26
12 cans per
case
B4161
00087-049801
049911
RTU
32 fl oz can
640
32
6 cans per
case
B4161
00087-049901
143701
RTU
2 fl oz bottle
40
2
48 bottles
per case
B4161
00087-143741
026306
RTU
6 fl oz bottle
120
6
24 bottles
per case
B4161
00087-026324
148501
RTU
8 fl oz bottle
160
8
24 bottles
per case
N/A
00087-510246
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
129023
Powder
14.1 oz can
(400g)
1960
98
4 cans per
case
B4161
00087-510478
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
036721
Powder
1 lb can
2240
112
6 cans per
case
B4161
00087-036701
143301
RTU, 20 Cal
2 fl oz bottle
40
2
48 bottles
per case
B4161
00087-143341
143401
RTU, 24 Cal
2 fl oz bottle
48
2
48 bottles
per case
B4161
00087-143441
PurAmino™
Pregestimil®
Enfamil® EnfaCare®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
001904
Powder
12.8 oz can
1800
82
6 cans per
case
B4160
00087-001944
139001
RTU
2 fl oz bottle
44
2
48 bottles
per case
B4160
00087-139041
128701
RTU
32 fl oz can
700
32
6 cans per
case
B4160
00087-128741
149501
RTU
8 fl oz bottle
1765
8
24 bottles
per case
N/A
00087-510298
Enfamil LIPIL®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
138801
RTU, 24 Cal
2 fl oz bottle
48
2
48 bottles
per case
B4158
00087-138841
Toddler Nutritionals
Enfagrow® Toddler Transitions™
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
154601
Powder
21 oz can
2960
148
4 cans per
case
B4158
00087-140151
154603
Powder
30 oz box
3840
211
4 boxes per
case
B4158
00087-510211
154901
RTU
32 fl oz can
640
32
6 cans per
case
B4158
00087-128841
Enfagrow® Toddler Transitions® Soy
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
140914
Powder
21 oz can
2820
141
4 cans per
case
B4159
00087-140944
Enfagrow® Toddler Transitions® Gentlease
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
146107
Powder
21 oz can
2960
148
4 cans per
case
B4158
00087-146142
Nutramigen® with Enflora® LGG® Toddler
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
154801
Powder
12.6 oz can
(357 g)
1720
86
6 cans per
case
N/A
00087-510734
Enfagrow® Toddler Next Step® Vanilla
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
869217
Powder
24 oz can
3040
130
4 cans per
case
B4158
00087-869247
Enfagrow® Toddler Next Step® Natural Milk Flavor (with Other Natural Flavor)
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
146712
Powder
24 oz can
2980
149
4 cans per
case
B4158
00087-146741
Special Medical Needs
Enfaport™
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
128901
RTU, 30 Cal
8 fl oz can
240
8
24 cans per
case
B4160
00087-128941
Portagen®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
038721
Powder
1 lb can
2100
70
6 cans per
case
B4158
00087-038701
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
042521
Powder
1 lb can
2270
Varies
6 cans per
case
B4161
00087-042541
Product 3232A
Metabolic / Diet Modifiers
BCAD 1
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
892801
Powder
1 lb can
2280
Varies
6 cans per
case
B4162
00087-510184
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891501
Powder
1 lb can
1860
Varies
6 cans per
case
B4162
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
BCAD 2
GA
Powder
1 lb can
2280
Varies
6 cans per
case
B4162 or
B4162
00087-510188
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
893301
Powder
1 lb can
2280
Varies
6 cans per
case
B4162
00087-510202
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891901
Powder
1 lb can
1860
Varies
6 cans per
case
B4157 or
B4162
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
893101
Powder
1 lb can
2280
Varies
6 cans per
case
B4157 or
B4162
00087-510196
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
893201
Powder
1 lb can
2280
Varies
6 cans per
case
B4162
00087-510199
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
892901
HCY 1
HCY 2
LMD
OA 1
OA 2
Item Number
Powder
1 lb can
1860
Varies
6 cans per
case
B4157 or
B4162
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
892701
Powder
1 lb can
2410
Varies
6 cans per
case
B4155
00087-510178
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891601
Powder
1 lb can
1820
Varies
6 cans per
case
B4155
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
892601
Powder
1 lb can
2280
Varies
6 cans per
case
B4162
00087-510172
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891301
Powder
1 lb can
1860
Varies
6 cans per
case
B4162
N/A
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891701
PFD Toddler
PFD 2
Phenyl-Free® 1
Phenyl-Free® 2
Phenyl-Free® 2 HP
Item Number
Powder
1 lb can
1770
Varies
6 cans per
case
B4157 or
B4162
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
893001
Powder
1 lb can
2280
Varies
6 cans per
case
B4162
00087-510191
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
891801
Powder
1 lb can
1860
Varies
6 cans per
case
B4162
N/A
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
893401
Powder
1 lb can
2270
Varies
6 cans per
case
B4162
00087-510205
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
892001
Powder
1 lb can
1860
Varies
6 cans per
case
B4157 or
B4162
N/A
891401
TYROS 1
TYROS 2
WND® 1
WND® 2
Human Milk Fortifier
Enfamil® Human Milk Fortifier
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
146301
Liquid
5 mL vial
7.5
5mL
200 vials per
case
N/A
00087-146341
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
134601
RTU
2 fl oz bottle
10
2
48 bottles
per case
N/A
00087-134641
Glucose Water
5% Glucose Water
Oral Electrolytes Solutions
Enfamil® Enfalyte®
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
026506
RTU
6 fl oz
22
6
24 bottles
per case
N/A
00087-026524
026509
RTU
2 fl oz bottle
7.3
2
48 bottles
per case
N/A
00087-5100943
Dietary Supplements
Expecta® LIPIL® DHA Supplement
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
3006E7
Expecta DHA
Multivitamin
Combo Pack
12 Combo
Packs
N/A
N/A
12 cartons
per case
N/A
00087-510585
Enfamil® D-Vi-Sol™ Drops
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
086604
With Dropper
50 mL
N/A
N/A
12 bottles
per case
N/A
00087-086644
Enfamil® Poly-Vi-Sol® Drops
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
040265
With Dropper
50 mL
N/A
N/A
12 bottles
per case
N/A
00087-040203
Enfamil® Poly-Vi-Sol® Drops
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
040506
With Dropper
50 mL
N/A
N/A
12 bottles
per case
N/A
00087-040501
Enfamil® Tri-Vi-Sol® Drops
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
040365
With Dropper
50 mL
N/A
N/A
12 bottles
per case
N/A
00087-040303
Enfamil® Fer-In-Sol® Drops
Item Number
Description
Unit Size
Calories /
Unit
Product Yield
/ Unit (fl oz)
Case
HCPCS Code
Reimbursement
Code
074026
With Dropper
50 mL
N/A
N/A
12 bottles
per case
N/A
00087-074002