HCPCS code B4087: Gastrostomy/jejunostomy tube billing guide

Key Takeaways

HCPCS code B4087 describes a standard gastrostomy or jejunostomy tube, any material, any type, billed each under the Medicare Part B DME benefit.

A valid Standard Written Order (SWO) from the treating physician, plus supporting medical-record documentation of medical necessity, must be on file before submitting a B4087 claim, since a missing or inadequate SWO is the leading denial reason.

B4087 covers the standard (conventional) tube, while B4088 covers low-profile (button-style) devices, and selecting the wrong one triggers automatic claim rejection.

Pabau’s claims management software and digital forms help practices track SWO completeness, document medical necessity, and submit enteral access device claims accurately.

HCPCS code B4087 is the billing code for a standard gastrostomy or jejunostomy tube under the CMS HCPCS Level II coding system. It sits within the Enteral and Parenteral Therapy supply category (B4000-B9999) and is processed by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

The code’s official long description is: Gastrostomy/jejunostomy tube, standard, any material, any type, each. The phrase “any material, any type” is intentional. CMS designed HCPCS code B4087 to be device-agnostic, covering silicone, polyurethane, and PVC tubes regardless of brand or construction, so billers do not need separate codes for each manufacturer’s variation.

B4087 code description and key details

The table below summarizes the administrative attributes of HCPCS code B4087 as defined in the current CMS HCPCS Level II data file.

Note the “each” unit of service at the end of the long description. Submit one unit per tube supplied, not per patient encounter. Submitting multiple units without corresponding documentation for each device is a common audit trigger.

2026 Medicare fee schedule for HCPCS code B4087

Reimbursement for HCPCS code B4087 is set annually through the CMS DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) fee schedule. Rates vary by MAC jurisdiction. The figures below reflect published 2026 national averages. Always verify current rates against the CMS DMEPOS fee schedule for your jurisdiction before billing.

Because exact fee amounts change with each annual DMEPOS update, this guide does not publish specific dollar figures. Commercial sources list rates, but only the CMS HCPCS data file is authoritative. Pull the current DMEPOS fee schedule directly from CMS before billing B4087 for the first time each calendar year.

Medicare coverage criteria for B4087

Medicare Part B covers HCPCS code B4087 under the DME benefit when the patient has a permanent or long-term condition requiring enteral feeding and the tube is medically necessary. The referral often starts with a primary care visit, so practices running general practice software need the same SWO discipline as the DME supplier filling the order.

Providers handling enteral access device billing should also review HIPAA compliance requirements to ensure documentation handling meets federal standards.

Coverage applies when all of the following criteria are met:

• The patient has a permanent impairment of the alimentary tract that prevents adequate oral nutrition
• The patient requires enteral nutrition via a gastrostomy or jejunostomy tube as the primary means of sustenance
• The treating physician has documented medical necessity in a Standard Written Order (SWO) and supporting medical-record documentation
• The tube is supplied by a Medicare-enrolled DMEPOS supplier
• The patient is a Medicare Part B beneficiary who does not reside in a skilled nursing facility (SNF) at the time of supply

Medicare does not cover temporary post-surgical tubes expected to be removed within a few weeks. The benefit is designed for chronic conditions requiring long-term enteral access. Always verify Local Coverage Determination (LCD) policies with your specific DME MAC, as coverage criteria can include additional clinical documentation requirements.

Documentation requirements and medical necessity

Missing or inadequate documentation is the primary reason B4087 claims get denied. Good medical forms management is the compliance foundation that keeps DME claims out of the denial queue.

Every B4087 claim requires the following on file before submission:

• Standard Written Order (SWO): A complete, signed, and dated order from the treating physician specifying the item (gastrostomy/jejunostomy tube, standard type), the quantity, and the diagnosis or condition supporting the need. The SWO must be on file before the claim is submitted and must pre-date the supply date.
• Clinical notes: Supporting medical-record documentation showing the patient’s diagnosis, treatment plan, weight, nutritional assessment, expected duration of need, and the clinical rationale for a tube-based feeding route.
• Supplier enrollment confirmation: Evidence that the DMEPOS supplier is enrolled and in good standing with Medicare at the time of supply.

CMS discontinued Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) for claims with dates of service on or after January 1, 2023. Suppliers no longer complete, submit, or maintain either form, and claims received with one attached are rejected. Coverage for B4087 rests on the SWO plus the supporting medical-record documentation above, not a CMN.

Even before 2023, enteral nutrition items such as B4087 were documented with a DIF (CMS Form 10126) rather than a CMN. CMNs applied to a different item set, including oxygen equipment, TENS units, pneumatic compression devices, osteogenesis stimulators, and seat-lift mechanisms.

Practices using digital forms can standardize SWO collection and physician order workflows, reducing the risk of missing or unsigned documents at the time of claim submission. The same intake stack should capture the patient’s consent for treatment alongside the SWO, since tube placement is itself a procedure requiring documented consent.

Keeping records audit-ready is especially important for DME suppliers subject to Medicare post-payment review. Our guide to secure patient documentation covers the broader compliance picture.

Streamline your DME billing workflows

Pabau helps practices managing enteral access device billing centralize SWO documentation, track physician orders, and reduce claim errors with automated workflows.

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ICD-10 diagnosis codes that support medical necessity

Pairing HCPCS code B4087 with an appropriate ICD-10-CM diagnosis code is required to establish medical necessity on the claim. The diagnosis must reflect the underlying condition that necessitates the gastrostomy or jejunostomy tube.

The same status-code logic shows up elsewhere in the digestive system, such as Z90.3 for a patient with an acquired absence of stomach. Conditions with a metabolic or nutritional root cause, like those tracked by metabolic health practices, carry this same coding requirement.

Always cross-reference this list against your DME MAC’s current LCD. Some MACs publish expanded ICD-10 supporting diagnosis lists, and diagnosis codes must be active and valid for the date of service. Verify codes against the CDC ICD-10-CM tool before claim submission.

Long-term enteral feeding patients are also monitored for nutrition-related complications beyond the GI tract. Malabsorption in older adults sometimes surfaces as senile osteomalacia, coded separately under M83.1, but the diagnosis is often discovered during the same nutritional workup that supports the enteral feeding order.

B4087 vs B4088: Standard vs low-profile tubes

B4087 and B4088 cover two clinically distinct product types. Selecting the wrong code is one of the most common B-range billing errors because the devices look similar in supplier catalogs. The distinction is based on the tube’s physical profile, not the insertion site.

The physician order and supplier delivery documentation must specify the tube type. If the order says “standard G-tube” but the supplier ships a button-style device and bills B4087, that mismatch constitutes incorrect coding. Train intake staff to confirm device specifications against the HCPCS description before the order is fulfilled.

Tube placement itself is billed separately from the device. Facilities administering local anesthesia during insertion, such as a ropivacaine hydrochloride injection billed under J2795, code that part of the procedure independently rather than folding it into the DME claim.

Related HCPCS codes for gastrostomy, jejunostomy, and enteral feeding

HCPCS code B4087 sits within a family of gastrostomy, jejunostomy, and enteral feeding tube codes. Billers working with enteral access devices should be familiar with the full range for accurate code selection. Patients who receive a B4087 tube often need enteral formula billed separately under B4150, and some also need an in-line digestive enzyme cartridge billed under B4105.

Some coding tools and older references still list B4084 (gastrostomy/jejunostomy tube, 12 French or greater, not low profile) as if it were a current alternative to B4087. CMS deleted B4084 effective January 1, 2002, so treat any source that still shows it as outdated, and bill B4087 or B4088 based on the device’s profile instead.

Check current code status against the AAPC’s HCPCS Level II lookup when in doubt.

Common billing errors and how to avoid them

DME enteral tube billing draws a higher rate of post-payment review than many other HCPCS categories. Catching common errors before a claim reaches the payer costs far less than fighting a recoupment request after the fact. Choosing medical billing software that flags incomplete documentation before submission helps prevent the errors below.

• Missing or inadequate SWO: The single most common denial reason. CMS discontinued CMNs and DIFs for dates of service on or after January 1, 2023, so today’s requirement is a complete, signed Standard Written Order plus medical-record notes establishing diagnosis, treatment plan, and expected duration of need. An SWO that is unsigned, undated, or missing the device specification is treated as no order at all.
• B4087 vs B4088 mismatch: Billing B4087 (standard) when the device supplied is a low-profile button (B4088) is an incorrect code selection. Verify device type against the physician order and delivery records.
• Incorrect ICD-10 pairing: Using a diagnosis code that does not appear on the MAC’s LCD supporting diagnosis list will result in denial. Confirm your ICD-10-CM code is on the current approved list for B4087. This scrutiny is not unique to enteral codes. A claim paired with M06.9 for rheumatoid arthritis faces the same MAC-specific LCD review.
• Wrong unit count: B4087 is billed per each tube. Submitting a unit count higher than the number of devices actually supplied without documentation creates an overpayment risk.
• Non-enrolled supplier: Claims submitted by a DMEPOS supplier that is not actively enrolled in Medicare will be denied regardless of clinical necessity. Verify enrollment status before accepting an order.

How Pabau supports enteral nutrition DME billing

Enteral access device billing usually fails for administrative reasons, not clinical ones. An SWO missing a required element, a physician order never attached to the patient record, or a diagnosis code that is one digit off are workflow problems, not coding knowledge problems. The claims management software inside Pabau helps billing teams catch these issues before a claim goes out.

Pabau’s client records centralize physician orders, SWOs, and clinical notes in one place, so billing staff can verify documentation completeness without hunting across multiple systems. Teams that have moved toward going paperless report fewer documentation-related denials because every form is timestamped, searchable, and linked directly to the patient record.

For practices managing automated billing workflows, Pabau can flag incomplete SWOs and prompt the billing team to collect the missing signature, date, or device detail before the claim goes out. Combining EHR integration with structured claim submission reduces the back-and-forth that delays reimbursement on B-range enteral codes.

Conclusion

Most B4087 claim denials trace back to one preventable cause: A missing or inadequate SWO. Getting the code right is the easy part. The harder discipline is ensuring that every physician order, supporting medical-record note, and ICD-10 diagnosis is accurate, current, and attached to the claim before it goes out the door.

Pabau’s claims management tools and automated document workflows help DME billing teams resolve those issues systematically, so B4087 claims get paid on first submission. To see how Pabau handles enteral nutrition billing documentation, book a demo with the team.

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Frequently asked questions