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  4. CLINIMIX 4.25/10 sulfite-free (4.25% Amino Acid in 10% Dextrose) Injection, 2000 mL in CLARITY Dual Chamber Container
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CLINIMIX 4.25/10 sulfite-free (4.25% Amino Acid in 10% Dextrose) Injection, 2000 mL in CLARITY Dual Chamber Container
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Item Number: 2B7705
GTIN:  0303381091040
GTIN-CS:  50300338109105
CLINIMIX 4.25/10 sulfite-free (4.25% Amino Acid in 10% Dextrose) Injection 2000 mL in CLARITY Dual Chamber Container. NDC 0338-1091-04
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Specifications

Product Characteristics

Minimum Storage Temperature 15.0 °C
Maximum Storage Temperature 25.0 °C
Volume 2000.0 ml
Latex Free Yes
Shelf Life from Manufacture 24 Months
Acetate 37 mg/L
Amino Acid Concentration 4.25%
Amino Acid 170 Kcal/L
Chloride 17 mg/L
Container Type CLARITY
Containes Preservative No
Dextrose Concentration 10%
Dextrose 340 Kcal/L
Free Water Content 1815
Nitrogen 7.02 g/L
Osmolarity Molperl 930
pH 6
Protein 42.5 g/L
Rx Only Yes
Specific Gravity 1.05
Storage Recommendations Store at room temperature (25°C/77°F) (may briefly store at up to 40°C/104°F). Refrigerated storage is limited to 9 days once the protective foil overwrap has been opened. Protect from freezing.
Total Calories 510 Kcal/L

Carton

Units per Case 4.0
Carton Weight 19.82 lb.
Carton Length 19.69 in.
Carton Width 9.45 in.
Carton Height 8.6 in.
Carton Volume 0.93 fc

Reimbursement Information

HCPCS Code HCPCS Description
B4189 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX
B4193 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX
B4197 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, 74 TO 100 GRAMS OF PROTEIN - PREMIX
B4199 PARENTERAL NUTRITION SOLUTION, COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, OVER 100 GRAMS OF PROTEIN - PREMIX
Medication Delivery Reimbursement Hotline 888-338-0001

Information Source : CMS

Disclaimer:The coverage, coding, and payment information included in this guide has been compiled from various resources for informational use as a tool to assist providers with reimbursement issues. This information is current as of 3/31/2008; however this information is subject to change and should not be construed as legal advice. Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect services rendered to individual patients. Baxter Healthcare Corporation does not guarantee success in obtaining insurance payments. Providers are encouraged to contact third-party payors for specific information on their coverage, coding, and payment policies.
Ordering Information
Item Number 2B7705
Sales Unit case
GTIN 0303381091040
GTIN-CS 50300338109105
National Drug Code 00338109104
Documents

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