`B4036` Enteral feed sup kit grav by

Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 1 units per claim line, rationale: Code Descriptor / CPT Instruction

Medicare pricing for B4036

PEN fee schedule, January 2026 (DME26-A)

no modifier, parenteral and enteral nutrition: non-rural $5.21 to $5.45 in the contiguous states; $8.24 in AK, HI, PR and VI; rural $8.20

Payer policies and prior authorization for B4036

26 of 26 payer prior-auth lists that name B4036 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Blue Shield of California, Molina Healthcare of Iowa, Passport by Molina Healthcare (Kentucky), UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	State exception; PA above 1 unit per calendar month	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	Louisiana Medicaid (Healthy Louisiana)	LA	prior auth required		Jan 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Michigan Medicaid, Healthy Michigan Plan, CSHCS	MI	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Michigan, Healthy Michigan Plan and Children’s Special Health Care Services Effective October 1, 2026
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth under conditions	Age 5+; Age under 5	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	Ohio Medicaid	OH	prior auth required		Nov 1, 2025	Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth required		May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	Texas CHIP	TX	prior auth required		May 1, 2019	Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community Plan	Texas STAR	TX	prior auth required		May 1, 2019	Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community Plan	Texas STAR Kids	TX	prior auth required		May 1, 2019	Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community Plan	Texas STAR+PLUS	TX	prior auth required		May 1, 2019	Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Hawaii (QUEST Integration)	HI	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Washington Apple Health	WA	prior auth required		Oct 1, 2026	Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth required		Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name B4036

B4036 appears in 7 coverage policies from Aetna, Anthem, Blue Cross Blue Shield of Massachusetts, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Eating Disorders (0511)	covered if criteria are met (range B4034-B4036)	Aug 4, 2026	payer document
Aetna	Nutritional Support (0061) Enteral lactoferrin supplementation	covered if criteria are met (range B4034-B4083)	Jan 15, 2026	payer document
Aetna	Pediatric Intensive Feeding Programs (0809)	listed, no stance (range B4034-B4162)	Dec 11, 2025	payer document
Anthem	Home Enteral Nutrition (CG-MED-08)	covered if criteria are met	Aug 13, 2026	payer document
Blue Cross Blue Shield of Massachusetts	Special Foods (304)	listed, no stance		payer document
Regence	Enteral and Oral Nutrition Therapy in the Home Setting (Allied Health 05)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Enteral Nutrition (Oral and Tube Feeding) (for North Carolina Only) (CSNC.MP.104.06)	listed, no stance	Sep 1, 2026	payer document

Recent prior-auth changes

Jul 1, 2026: conditions changed, Passport by Molina Healthcare (Kentucky)
Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan
Oct 1, 2025: conditions changed, Passport by Molina Healthcare (Kentucky)
Oct 1, 2025: conditions changed, UnitedHealthcare Community Plan
Jul 1, 2025: conditions changed, Passport by Molina Healthcare (Kentucky)
Feb 19, 2025: PA removed, Molina Healthcare of Texas
Feb 19, 2025: PA removed, Molina Healthcare of Texas
Jan 1, 2025: PA removed, Molina Healthcare of Texas
Apr 1, 2024: PA removed, Molina Complete Care (Virginia)
Apr 1, 2024: PA removed, Molina Complete Care (Virginia)

Medicaid fee-for-service

Prior authorization required or conditional in CO, LA, MA, ND, NY, OH, VA, WV.

AZ: $6.96 (dme), effective Oct 1, 2026
CO: $6.97 (chp_plus, non-facility), effective Jul 1, 2026
FL: $6.55 (dme), effective Jul 1, 2026
IL: $7.06 (dme), effective Jan 1, 2026
IN: $4.26 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $3.64 (default), effective Jul 1, 2022
KY: $226.61 (dme), effective Jan 1, 2026
LA: $4.92 (dme), effective Sep 1, 2021
MA: $4.34 (dme_rates), effective Mar 1, 2026
MD: $6.80 (dme), effective Apr 1, 2026
MS: $6.56 (comprehensive), effective Jul 1, 2026
ND: $0.00 (dme), effective Aug 1, 2026
NE: $10.48 (dme), effective Jul 1, 2026
NY: $4.34 (dme), effective Jul 1, 2026
OH: $4.85 (dme), effective Jan 1, 2010
OK: $10.25 (dme), effective Jan 1, 2026
TX: $8.00 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Jan 1, 2014
VA: $8.20 (dme), effective Dec 1, 2026
VT: $6.86 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $7.91 (enteral_nutrition), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

B4036 Enteral feed sup kit grav by