Billing Information
Liquid Hope
(ADULT FORMULA)
- HCPCS Code: B4149
- Insurance Data Bank & Billing Code:
57858-0004-11* - SID#: 201306012001, 20200224001
- Product: LHWS124
Liquid Hope Peptide
ADULT FORMULA
- HCPCS Code: B4153
- Insurance Data Bank & Billing Code:
57858-0004-28* - SID#: 20130612001
- Product: LHPWS124
Liquid Hope Peptide High Protein
ADULT FORMULA
- HCPCS Code: B4153
- Insurance Data Bank & Billing Code:
57858-0004-32 - SID#: 20161118001
- Product: LHHPWS124
Liquid Hope Peptide Berry Medley
ADULT FORMULA
- HCPCS Code: B4153
- Insurance Data Bank & Billing Code:
57858-0004-50 - SID#: 2022-0809/002
- Product: LHPBWS124
Nourish
PEDIATRIC FORMULA
- HCPCS Code: B4149
- Insurance Data Bank & Billing Code:
57858-0004-12* - SID#: 20161118001, 20200224001
- Product: NWS124
Nourish Peptide
PEDIATRIC FORMULA
- HCPCS Code: B4161
- Insurance Data Bank & Billing Code:
57858-0004-27* - SID#: 20161118001
- Product: NOUPWS124
Nourish Peptide Berry Medley
PEDIATRIC FORMULA
- HCPCS Code: B4161
- Insurance Data Bank & Billing Code:
57858-0004-44 - SID#: 20161118001
- Product: NOUPBWS124
Keto
Ketogenic Formula
- HCPCS Code: B4153, B4161
- Insurance Data Bank & Billing Code:
57858-0004-24* - SID#: 20200131002
- Product: KEWS124
*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.
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.
