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  4. CLINIMIX 5/20 sulfite-free (5% Amino Acid in 20% Dextrose) Injection, 1000 mL in CLARITY Dual Chamber Container
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CLINIMIX 5/20 sulfite-free (5% Amino Acid in 20% Dextrose) Injection, 1000 mL in CLARITY Dual Chamber Container
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Item Number: 2B7731
GTIN:  0303381138035
GTIN-CS:  50300338113805
CLINIMIX 5/20 sulfite-free (5% Amino Acid in 20% Dextrose) Injection 1000 mL in CLARITY Dual Chamber Container. NDC 0338-1138-03
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Specifications

Product Characteristics

Minimum Storage Temperature 2.0 °C
Maximum Storage Temperature 25.0 °C
Volume 1000.0 ml
Latex Free Yes
Shelf Life from Manufacture 24 Months
Acetate 42 mg/L
Amino Acid Concentration 5%
Amino Acid 200 Kcal/L
Chloride 20 mg/L
Container Type CLARITY
Containes Preservative No
Dextrose Concentration 20%
Dextrose 680 Kcal/L
Free Water Content 840
Nitrogen 8.26 g/L
Osmolarity Molperl 1505
pH 6
Protein 50 g/L
Rx Only Yes
Specific Gravity 1.09
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 880 Kcal/L

Carton

Units per Case 6.0
Carton Weight 19.5 lb.
Carton Length 18.5 in.
Carton Width 9.75 in.
Carton Height 13.0 in.
Carton Volume 1.36 fc

Reimbursement Information

HCPCS Code HCPCS Description
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
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
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
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
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 2B7731
Sales Unit case
GTIN 0303381138035
GTIN-CS 50300338113805
National Drug Code 00338113803
Documents

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