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Reimbursement Codes

PhenylAde® Essential

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
9501 PhenylAde® Essential Chocolate Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0950-12
9502 PhenylAde® Essential Vanilla Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0950-22
9503 PhenylAde® Essential Orange Creme Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0950-32
9504 PhenylAde® Essential Strawberry Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0950-42
9508 PhenylAde® Essential Unflavored Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0950-82
95014 PhenylAde® Essential Chocolate Powder 1 pouch (40g) 16 pouches per case B4157 or B4162 S9435 00847-0950-14
95024 PhenylAde® Essential Vanilla Powder 1 pouch (40g) 16 pouches per case B4157 or B4162 S9435 00847-0950-24
95034 PhenylAde® Essential Orange Creme Powder 1 pouch (40g) 16 pouches per case B4157 or B4162 S9435 00847-0950-34
95044 PhenylAde® Essential Strawberry Powder 1 pouch (40g) 16 pouches per case B4157 or B4162 S9435 00847-0950-44
95084 PhenylAde® Essential Unflavored Powder 1 pouch (40g) 16 pouches per case B4157 or B4162 S9435 00847-0950-84

PhenylAde® GMP

Product CodeProductFlavorDescriptionUnit SizeCaseHCPS CodeReimbursement Code
6832 PhenylAde® GMP Drink Mix Vanilla Powder 1 can (400 g) 4 cans per case B4157 or B4162  49735-0168-32
9502 PhenylAde® GMP Drink Mix Vanilla Powder 1 pouch (33.3 g) 16 pouches per case B4157 or B4162  49735-0183-04
 114116 PhenylAde® GMP Drink Mix
Original Powder 1 pouch (33.3 g)
16 pouches per case
B4157 or B4162
49735-0141-16
9502 PhenylAde® GMP Mix-In Unflavored Powder 1 pouch (12.5 g) 20 pouches per case B4155 49735-0111-61

PhenylAde® 40 Drink Mix

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
95404 PhenylAde® 40 Drink Mix Unflavored Powder 1 pouch (25g) 20 pouches per case B4157 or B4162 S9435 00847-0954-04
95414 PhenylAde® 40 Drink Mix Citrus Powder 1 pouch (25g) 20 pouches per case B4157 or B4162 S9435 00847-0954-14

PhenylAde® 60 Drink Mix

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
9560 PhenylAde® 60 Drink Mix Unflavored Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0956-02
9562 PhenylAde® 60 Drink Mix Vanilla Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0956-22
95604 PhenylAde® 60 Drink Mix Unflavored Powder 1 pouch (16.7g) 30 pouches per case B4157 or B4162 S9435 00847-0956-04
95624 PhenylAde® 60 Drink Mix Vanilla Powder 1 pouch (16.7g) 30 pouches per case B4157 or B4162 S9435 00847-0956-24

PhenylAde® Amino Acid Blends

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
9500 PhenylAded Amino Acid Blend Unflavored Powder 1 can (454g) 4 cans per case B4155 or B9998 S9435 00847-0950-00
9596 PhenylAde MTE Amino Acid Blend Unflavored Powder 1 can (454g) 4 cans per case B4155 or B9998 S9435 00847-0959-60
95004 PhenylAde Amino Acid Blend Unflavored Powder 1 pouch (12.4g) 30 pouches per case B4155 or B9998 S9435 00847-0950-04
95964 PhenylAde MTE Amino Acid Blend Unflavored MTE Powder 1 pouch (12.8g) 30 pouches per case B4155 or B9998 S9435 00847-0959-64

Large Neutral Amino Acids (LNAAs)

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
95501 PhenylAde PheBLOC Unflavored Tablets 1 tablet (750mg) 550 tablets per jar B9998 or S9435 00847-0955-01
95504 PhenylAde PheBLOC Unflavored Powder 1 pouch (3g) 110 pouches per case B4155 or S9435 00847-0955-04
12643 Lanaflex™ Orange Powder 1 pouch (15.38g) 40 pouches per case B4157 or S9435 00847-0955-01

Maxamum® Range

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code

             
118323 XPhe Maxamum® Unflavored Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-0183-23
118324 XPhe Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-0183-24
12312 XPhe Maxamum® Orange Sachets 1 sachet (50g) 30 sachet per case B4157 or B4162 49735-0123-12
12311 XPhe Maxamum® Unflavored Sachets 1 sachet (50g) 30 sachet per case B4157 or B4162 49735-0123-11








PKU Lophlex® Range

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
86021 PKU Lophlex® LQ  Mixed Berry Blast Ready to Drink 1 unit (125mL)  4.2 fl oz 30 units per case B4157 or B4162 49735-0161-29
86055 PKU Lophlex® LQ Juicy Tropical Ready to Drink 1 unit (125mL) 4.2 fl oz 30 units per case B4157 or B4162 49735-0195-35
86051 PKU Lophlex ® LQ  Juicy Orange Ready to Drink 1 unit (125mL)  4.2 fl oz 30 units per case B4157 or B4162 49735-0161-30








Periflex® Range

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90164 Periflex® Early Years Unlflavored Powder 1 can (400 g) 6 cans per case B4162 49735-0101-64
89477 PKU Periflex® Junior Plus Plain Powder 1 can (400 g) 6 cans per case B4162 49735-0194-77
89476 PKU Periflex® Junior Plus Orange Powder 1 can (400 g) 6 cans per case B4162 49735-0194-76
89474 PKU Periflex® Junior Plus Berry Powder 1 can (400 g) 6 cans per case B4162 49735-0194-74
89478 PKU Periflex® Junior Plus Vanilla Powder 1 can (400 g) 6 cans per case B4162 49735-0194-78
118305 Periflex® Advance Unlflavored Powder 1 can (454 g) 6 cans per case B4162 or B4157 49735-0183-05
118307 Periflex® Advance Orange Powder 1 can (454 g) 6 cans per case B4162 or B4157 49735-0183-07
80176 Periflex® LQ Berry Crème Ready-to-Drink 1 unit (250 mL) 18 units per case B4157 or B4162 49735-0125-24
80177 Periflex® LQ Orange Crème Ready-to-Drink 1 unit (250 mL) 18 units per case B4157 or B4162 49735-0125-51

Phlexy-10® System

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
11467 Phlexy-10® Drink Mix Black Currant/Apple Powder 1 sachet (20g) 30 sachets per case B4157 or B4162 49735-0114-67
11910 Phlexy-10® Drink Mix Tropical Surprise Powder 1 sachet (20g) 30 sachets per case B4157 or B4162 49735-0119-10
11809 Phlexy-10® Capsules n/a Capsules 1 bottle (200 capsules) 1 bottle per case S9434 to A920 49735-0118-09
11951 Phlexy-10® Tablets n/a Tablets 1 bottle (75 tablets) 1 bottle per case S9434 to A920 49735-0119-51

Glutaric Acidemia

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90217 GA1 Anamix® Early Years Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0102-17
117788 XLys,XTrp Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-0177-88
7510 GlutarAde Junior Vanilla Powder 1 can (400g) 4 cans per case B4157 or B4162 S9435 00847-0751-02
7542 GlutarAde™ Essential Vanilla Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0754-22
7500 GlutaraAde™ Amino Acid Blend Unflavored Powder 1 can (454g) 4 cans per case B4155 or B9998 S9435 00847-0750-00

Homocystinuria

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90169 HCU Anamix® Early Years Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0101-69
89470 HCU Anamix® Next Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0194-70
117795 XMet Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-0177-95
659357 Milupa HOM 2 Unflavored Powder 1 can (500g) 2 cans per case B4155 81361-0935-70
66748 HCU Lophlex® LQ Mixed Berry Blast Ready to Drink 1 unit  (125mL) 4.2 fl oz 30 units per case B4157 or B4162 49735-0167-48

Maple Syrup Urine Disease

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90168 MSUD Anamix® Early Years Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0101-02
659351 Milupa MSUD 2 Unflavored 659351 1 can (500g) 2 cans per case B4155 81361-0935-10
117789 MSUD Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-0177-89
66749 MSUD Lophlex® LQ Mixed Berry Blast Ready to Drink 1 unit  (125mL) 4.2 fl oz 30 units per case B4157 or B4162 49735-0167-48
5910 Complex® Junior MSD Drink Mix Unflavored Powder 1 can (400g) 4 cans per case B4157 or B4162 S9435 00847-0591-02
5972 Complex® MSD Essential Drink Mix Vanilla Powder 1 can (454g) 4 cans per case B4157 or B4162 S9435 00847-0597-22
5900 Complex® MSD Amino Acid Blend Unflavored Powder 1 can (454g) 4 cans per case B4155 or B9998 S9435 00847-0590-00

Tyrosinemia

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90218 TYR Anamix® Early Years Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0102-18
89479 TYR Anamix® Next Unflavored Powder 1 can (400g) 6 cans per case B4162 49735-0194-79
66750 TYR Lophlex® LQ Mixed Berry Blast Ready to Drink 1 unit (125mL) 4.2 fl oz 30 units per case B4157 or B4162 49735-0177-86

Isovaleric Acidemia

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90211 IVA Anamix® Early Years Unflavored Powder 1 can (400g) 4 cans per case B4162 49735-0102-11
89471 IVA Anamix® Next Unflavored Powder 1 can (400g) 4 cans per case B4162 49735-0194-71
117790 XLeu Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-01-7790

Methylmalonic and Propionic Acidemia 
Product CodeProductFlavorDescriptionUnit SizeCaseHCPS CodeReimbursement Code
90215 MMA-PA Anamix® Early Years Unflavored Powder 1 can (400g) 4 cans per case B4162 49735-0102-15
89472 MMA-PA Anamix® Next Unflavored Powder 1 can (400g) 4 cans per case B4162 49735-0194-72
117779 XMTVI Maxamum® Orange Powder 1 can (454g) 6 cans per case B4157 or B4162 49735-01-7779

Urea Cycle Disorder

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
59293 UCD Anamix Junior Vanilla Powder 1 can (400g) 6 cans per case B4157 or B4162 49735-0192-93
59292 UCD Anamix Junior Unflavored Powder 1 can (400g) 6 cans per case B4157 or B4162 49735-0192-92
659361 Milupa UCD 2 Unflavored Powder 1 can (500g) 2 cans per case B4155 81361-0936-10
11490-1 Essential Amino Acid Unflavored Powder 1 can (200g) 2 cans per case B9998 49735-0133-42

Fatty Acid Oxidation Disorder

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
106033 Monogen Unflavored Powder 1 can (400g) 6 cans per case B4150 or B4158 49735-016033
71957-3 Liquigen Unflavored Ready to Feed Liquid 1 bottle (250mL) 4 bottles n/a 49735-0195-73

Single Amino Acids - Pure Amino Acid Powder

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
0120A L-Arginine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0012-00
0130G Glycine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0013-00
0140I L-Isoleucine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0014-00
0150L L-Leucine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0015-00
0160T L-Tyrosine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0016-00
0170V L-Valine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 00847-0017-00
180M L-Methionine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 49735-0101-80
190T L-Threonine n/a Powder 1 bottle (50g) 1 bottle B9998 or S9435 49735-0101-90

Other Nutrionals

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
118262 (can) Super Soluble Duocal® Unflavored Can 1 can (400g) 6 cans per case B4155 49735-0182-62
10281 (sachet) Super Soluble Duocal® Unflavored Sachet 1 sachet (10g) 40 sachets per case B4155 49735-0102-81
10124-1 Complete Amino Acid Mix Unflavored Can 2 can (200g) 2 cans per case B4155 49735-0133-41
11490-1 Essential Amino Acid Mix Unflavored Can 2 can (200g) 2 cans per case B9998 to S9434 49735-0114-90
10685 Phlexy-Vits Unflavored Sachet 1 sachet (7g) 30 sachets per case A9270 49735-0106-85

Sulfite Oxidase Deficiency

Product Code Product Flavor Description Unit Size Case HCPS Code Reimbursement Code
90212 Special Order SOD Anamix® Early Years Unflavored Powder 1 can (400g) 3 cans per case B4162 49735-0102-12
11457-1 Special Order XMet, XCys Maxamaid® Unflavored Powder 1 can (500g) 2 cans per case B4162 49735-0114-57