EN Modular Products

Powder

Composition	Modular Brand Name, Manufacturer	Features	Specifics	HCPCS	Additional Details
Amino acids	Complete Amino Acid Mix, Nutricia	Essential and non-essential amino acids; 4.1 g/svg
Amino acids	Essential Amino Acid Mix, Nutricia	Essential amino acids
Glutamine; maltodextrin	Glutasolve, Nestlé
Collagen dipeptide	PUSH Collagen Dipeptide Concentrate, Global Health	5 g protein/svg	Contains pineapple and sucralose	Not billable
Amino acids arginine, vitamins	Arginaid, Nestlé
Amino acids	Hormel Vital Cuisine® L-Emental® Arginine Drink Mix, Hormel
Hydrolyzed collagen	Juven®, Abbott	Contains arginine (7 g/svg), glutamine (7 g/svg), beta-hydrox-beta-methyl-butyrate, zinc, vitamins C, E and B12; 2.5 g protein/svg		B4155
Whey protein	Active® Protein powder, Medline	6 g protein/svg
Whey protein	Beneprotein, Nestlé
Whey protein	ProCel® Protein powder, Whey, unflavored, Global Health	5 g protein/svg	Contains lactose and soy	B4155
Whey protein	RenaMent®, Medtrition	10 g protein/svg; low sodium, potassium and phosphorous	Contains milk	B4155
Whey protein	Vital Cuisine® ProPass ®, Hormel	6 g protein/svg	Contains lactose and soy
Whey and casein protein	ProSource® Protein Powder, Medtrition	6 g protein/svg	Contins milk and soy	B4155
Whey protein/amino acids	Argiment® AT, Medtrition	Contains a prebiotic, arginine , glutamine, zinc, copper and vitamin C; 10 g protein/svg	Contains milk	B4155
Whey protein/arginine	Argitein®, Medtrition	5 g protein/svg; 4.5 g L-arginine/svg	Contains milk	B4155	Sugar-free
Prebiotic and probiotic	Diff-Stat®, Nutricia	Fructo-oligosaccharides; saccharomyces boulardii, bacillus coagulans	Contains milk and sucralose	No code
Soluble fiber	Banatrol® Plus with Prebiotic-updated weblink, Medline	Banana flakes; 2 g/svg; prebiotics		B4104
Soluble fiber	FiberCel® Fiber Powder, Global Health	5 g fiber/svg		B4155	Lactose-free, gluten-free
Soluble fiber/transgalacto-oligosaccharide	Banatrol Plus®, Medtrition	Banana flakes; 2 g fiber/svg; transalacto-oligosaccharide	Contains milk	B4104
Vitamins/minerals	Phlexy-Vits®, Nutricia	Multi vitamin and mineral supplement
	UtyMax®, Medtrition	Cranberry concentrate	Contains sucralose	B4101
Energy and protein	RenaMent®, Medtrition	Whey protein 10 g and 230 kcals/svg	Contains milk	B4155
Protein-free energy	DuoCal®, Nutricia	492 kcals/100 g
Soluble fiber	Nutrisource® Fiber, Nestlé
L-Arginine	Vital Cuisine® L-Emental®, Hormel	Antioxidants and zinc; 4.5 g arginine/svg
Glucose polymers	Polycal® I (Canada and the United Kingdom), Nutricia	18.6 carbohydrateg/svg		B4155

Liquid

Composition	Modular Brand Name	Features	Specifics	HCPCS	Additional Details
Hydrolyzed Pea Protein	Prosource® TF Free, Medtrition
Collagen/amino acids	ProSource® TF, Medtrition	11 g protein/svg		B4155	Lactose-free, gluten-free
Hydrolyzed collagen	Liquacel® Liquid Protein, Global Health	Contains arginine;16 g protein/svg		B4155
Collagen/aminoacids/ micronutrients	PUSH 20+ Wound Care Supplement, Global Health
Hydrolyzed collagen	Pro-Stat®, Nutricia
Hydrolyzed collagen	Pro-Stat® AWC, Nutricia	15 g protein/svg	Contains sucralose	B4155	Sugar-free
Hydrolyzed collagen	ProT Gold, OP2 Labs	17.5 g protein/svg; added arginine, cysteine, glutamine, histidine, methionine, taurine and tryptophan	Contains sucralose	B4155
Hyrdrolyzed collagen/ whey protein	Active® Liquid Protein, Regular and Sugar Free, Medline	16 g protein/svg		B4155	Lactose-free, gluten-free
Hydrolyzed collagen/ whey protein	Active® Liquid Protein, sugar-free, Critical Care, Medline	Contains arginine, zinc and vitamin C;21 g protein/svg		B4155
Hydrolyzed collagen/ whey protein	Active® TF Enteral Liquid Protein Nutritional Supplement, Medline	11 g protein/svg		B4155	Sugar-free, Lactose-free, gluten-free
Hydrolyzed collagen/ whey protein	ProHeal® Critical Care, DermaRite	17 g protein/svg; contains arginine and vitamin C		B4155
Hydrolyzed collagen/ whey protein	ProHeal® Liquid Protein, DermaRite	15 g protein/svg		B4155	Sugar-free; lactose-free and gluten-free
Hydrolyzed collagen/ whey protein	ProSource® NoCarb, Medtrition	15 g/svg; no carbohydrate	Contains milk	B4155
Hydrolyzed collagen/ whey protein	ProSource® Plus, Medtrition	15 g protein/svg	Contains milk	B4155
Hydrolyzed collagen/ whey protein	ProSource® TF20, Medtrition
Hydrolyzed collagen/ whey protein/arginine	ProSource® ZAC, Medtrition	21 g protein/svg w/3.2 g arginine; contains vitamine C and zinc	Contains milk, sucralose and acesulfame	B4155	Sugar-free
Hydrolyzed collagen/ whey protein/medium chain triglycerides	ProSource® XtraCal, Medtrition	14 g protein/svg; 230 kcals/svg	Contains milk	B4155
Hydrolyzed whey	Pro-Stat® MAX, Nutricia	11 g protein/svg		B4155	Sugar-free
Medium chain triglyderides	Liquigen®, Nutricia	Medium chain triglyceride oil; 15 g/oz		B4155
Soluble fiber	FiberHeal®, DermaRite	15 g fiber/svg; contains fructo-oligosaccharides
Soluble fiber	Fiber Stat®, Nutricia	15 g fiber/svg; fructo-oligosaccharides		B4104
Soluble fiber and prebiotic FOS	HyFiber®, Medtrition	12 g fibersvg; contains fructo-oligosaccharides		B4104
	UTIHeal®, DermaRite	Cranberry concentrate, vitamins C and D, fructo-oligosaccharides
	UTI-Stat®, Nutricia	Cranberry concentrate, vitamin C, fructo-oligosaccharides	Contains sucralose and acesulfame	B4104
Soluble fiber and prebiotics	Banatrol TF, Medtrition
Medium chain triglyderides	MCT Oil®, Nestlé