B4222 Parenteral supply kit homemiParenteral nutrition supply kit; home mix, per day
3 of 3 payer prior-auth lists that name B4222 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Blue Shield of California, Passport by Molina Healthcare (Kentucky).
| 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) |
| 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 |
B4222 appears in 12 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Molina Healthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Growth Hormone (GH) and Growth Hormone Antagonists (0170) | listed, no stance (range B4164-B5200) | Jun 26, 2026 | payer document |
| Aetna | Intestinal Transplantation (0605) | listed, no stance (range B4164-B5200) | Sep 3, 2026 | payer document |
| Aetna | Nutritional Support (0061) Enteral lactoferrin supplementation | covered if criteria are met (range B4102-B9999) | Jan 15, 2026 | payer document |
| Aetna | Pediatric Intensive Feeding Programs (0809) | listed, no stance (range B4164-B5200) | Dec 11, 2025 | payer document |
| Anthem | Home Parenteral Nutrition (CG-MED-89) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Intradialytic Parenteral Nutrition (CG-MED-99) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Intradialytic Parenteral Nutrition (L.8.01.413) | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | TPN (296) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Intradialytic Parenteral Nutrition (CAM 80144) | listed, no stance (range B4164-B5200) | Sep 1, 2026 | payer document |
| Centene | Total Parenteral Nutrition and Intradialytic Parenteral Nutrition Reference Number: CP.MP.163 (CP.MP.163) | covered if criteria are met (range B4164-B5200) | Jan 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Nutritional Support (MED201.011) HCPCS Codes B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4102, | listed, no stance | Jan 1, 2026 | payer document |
| Molina Healthcare | Regulatory Status | listed, no stance | payer document |
Prior authorization required or conditional in KY, MA, WY.
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.