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Reimbursement Information & Tips

To help make insurance reimbursement on eligible Solace Nutrition Medical Foods as seamless as possible, we’ve provided a list of our products according to the product line, along with coding required for insurance processing. In addition to the Product Code and packaging specifications for each, we’ve listed corresponding Universal Product (UPC), National Drug Company (NDC), and Healthcare Common Procedure Coding System (HCPCS) codes for your convenience.

Any questions relating to insurance, including questions concerning specific product formulation, medical necessity, and eligibility for reimbursement, can be directed to our team of Customer Service experts.

Product

Product Code

UPC Code

Reimbursement Code

HCPCS Code

Packaging Form

Mitochondrial

Cyto-Q

1201

8-57771-00701-3

57771-0007-01

A9270

1 box x 30 liquipaks

Cytotine

1202

8-57771-00191-6

57771-0001-91

B4155

1 bottle x 480 mL

Cytose

1203

8-57771-00120-6

57771-0001-20

A9270

1 container x 200 g

Cyto-Q MAX

1204

8-57771-00702-4

57771-0007-02

B4155

1 bottle x 170 mL

Cyto B2

1205

8-57771-00703-1

57771-0007-03

A9270

1 container x 100 g

Cyto-Q t/f

1206

8-57771-00704-8

57771-0007-04

B4155

2 x 170 mL bottles

Cyto B7

1207

8-57771-00192-3

57771-0001-92

B4155

1 bottle x 30 mL

Cyto Carn

1208

8-57771-00110-7

57771-0001-10

B4155

1 container x 100 g

Cyto RALA

1209

8-57771-00111-4

57771-0001-11

B4155

1 container x 30 g

Cytolline

1210

8-57771-00116-9

57771-0001-16

B4155

1 container x 275 g

Cyto B1

1213

8-57771-00126-8

57771-0001-26

B4155

1 container x 100 g

Cytotine Powder

1214

8-57771-00138-1

57771-001-38

B4155

1 container x 100 g

neoKe

neoKe BCAA4

6003

8-57771-00112-1

57771-0001-12

B4155

1 container x 300 g

neoKe MCT70

6004

8-57771-00114-5

57771-0001-14

B4155

1 container x 300 g

neoKe BHB

6005

8-57771-00134-3

57771-0001-34

B4155

1 container x 150 g

Metabolics

Galaxtra

4001

8-57771-00109-1

57771-0001-09

B4155

1 container x 375 g

MannXtra

4002

8-57771-00121-3

57771-0001-21

B4155

1 container x 375 g

GlyMax

4003

8-57771-00119-0

57771-0001-19

B4155

1 container x 225 g

VB7 MAX

4004

8-57771-00125-1

57771-0001-25

B4155

1 container x 100 g

VB12 MAX

4005

8-57771-00127-5

57771-0001-27

B4155

1 bottle x 30 mL

VB6 P5P

4006

8-57771-00132-9

57771-0001-32

B4155

1 container x 100 g

LDL Care

4007

8-57771-00137-4

57771-0001-37

B4155

1 container x 100 g

Cholesterol Synthesis

Cholextra t/f

5002

8-57771-00131-2

57771-0001-31

B4155

1 container x 110 g

CholexMax

5003

8-57771-00133-6

57771-0001-33

B4155

1 container x 125 g

SolMods

Sol Fiber

7002

8-57771-00115-2

57771-0001-15

B4104

1 container x 225 g

PureCarb

7003

8-57771-00129-9

57771-0001-29

B4155

1 container x 600 g

PKU

PreKUnil

8001

8-57771-00142-8

57771-0001-42

A9270

1 container x 550 tabs

NeoPhe

8002

8-57771-00143-5

57771-0001-43

A9270

1 container x 550 tabs

NeoPhe Powder

8003

8-57771-00144-2

57771-0001-44

B4157 or B4162

1 container x 376 g

Vitamins/Minerals

NanoVM 1-3 Powder

1113

8-57771-00113-8

57771-0001-13

B4104

1 container x 275 g

NanoVM 4-8 Powder

1148

8-57771-00148-0

57771-0001-48

B4104

1 container x 275 g

NanoVM 9-18 Powder

1918

8-57771-00105-3

57771-0001-05

B4104

1 container x 275 g

NanoVM t/f Powder

1190

8-57771-00104-6

57771-0001-04

B4104

1 container x 275 g

NanoVM Adult Powder

1125

8-57771-00135-0

57771-0001-35

B4104

1 container x 275 g

NanoVM Senior 71+ Powder

1171

8-57771-00136-7

57771-0001-36

B4104

1 container x 275 g


Solace Nutrition products may require a Prior Authorization (PA) to gain coverage. Click on the links below to obtain ordering numbers from Cardinal Health, McKesson, and McKesson Medical Surgical.
To determine your coverage options, contact your insurance company directly and inform them that your health care provider recommends a Solace Nutrition product for enteral nutrition. Often insurance companies cover Medical Foods under a DME or Durable Medical Equipment benefit. Insurance companies also cover Medical Foods under a benefit for Enteral Nutritional Therapy. 

Cardinal Health

5584644

CHOLEXMAX

5584685

CHOLEXTRA T/F

5584651

CYTO B1

4306601

CYTO B2

4935789

CYTO B7

5460654

CYTO CARN

5460662

CYTO RALA

4306452

CYTO-Q MAX BOTTLE

4111043

CYTO-Q PK 80/10 30X10ML LQ DSHP

4773073

CYTO-Q T/F UNFLAVORED LIPOSOMAL UBIQUINOL FOR TUBE

5460670

CYTOLLINE

4906244

CYTOSE 200GM

4306528

CYTOTINE

5682620

CYTOTINE POWDER

5460647

GALAXTRA

5460415

GLYMAX

5584693

LDL CARE

5460712

MANNXTRA

4945267

NANO VM 275 GM 1-3 PWD DSHP

4913893

NANO VM 275 GM 4-8 PWD DSHP

5067350

NANOVM 9-18 275 GM PWD

5584701

NANOVM ADULT 275 GM

5584719

NANOVM SENIOR 71+ 275 GM

5067319

NANOVM T/F 275GM PWD

5460696

NEOKE BCAA4

5584669

NEOKE BHB

5460704

NEOKE MCT70

5486600

PURECARB

5584727

VB6 P5P

McKesson Surgical

    • 971477 – NANOVM T/F POWD #1190
  • 923965 – VITAMIN POWD 275G AGES 4-8 

McKesson

  • 1315316 (NDC: 57771-0007-02) — CYTO-Q MAX LIQ UBIQ DS 170ML
  • 1344043 (NDC: 57771-0050-01) — PREKUNIL TAB 735MG DS 550
  • 1345867 (NDC: 57771-0050-01) — NEOPHE TAB 735MG DS 550
  • 1398361 (NDC: 57771-0070-10) — CYTO-Q LIQ 10ML PK CS30 DS
  • 2558062 (NDC: 57771-0007-03) — CYTO B2 PWD 100GM DS
  • 2558070 (NDC: 57771-0007-04) — CYTO-Q T/F 2X370ML DS
  • 2558096 (NDC: 57771-0001-92) — CYTO B7 LIQUID 30ML DS
  • 2558153 (NDC: 57771-0001-26) — CYTO B1 POWDER 100 GM DS
  • 2558187 (NDC: 57771-0001-38) — CYTOTINE POWDER 100GM DS
  • 2558880 (NDC: 57771-0001-12) — NEOKE BCAA4 POWDER 300GM DS
  • 2559169 (NDC: 57771-0001-14) — NEOKE MCT70 POWDER 300GM DS
  • 2559177 (NDC: 57771-0001-34) — NEOKE BHB POWDER 150GM DS
  • 2559185 (NDC: 57771-0001-21) — MANNXTRA POWDER 375GM DS
  • 2559300 (NDC: 57771-0001-19) — GLYMAX POWDER 225GM DS
  • 2559391 (NDC: 57771-0001-32) — VB6 P5P POWDER 100GM DS
  • 2559433 (NDC: 57771-0001-37) — VLDL CARE POWDER 100GM DS
  • 2559441 (NDC: 57771-0001-35) — NANOVM ADULT POWDER 275GM DS
  • 2559532 (NDC: 57771-0001-36) — NANOVM SENIOR 71+ PWD 275GM DS
  • 2578672 (NDC: 57771-0001-13) — VITAMIN POWD 275G AGES 1-3 DS
  • 2578698 (NDC: 57771-0001-48) — VITAMIN POWD 275G AGES 4-8 DS
  • 3554912 (NDC: 57771-0001-91) — CREATINE LQ ORG/PINEAPL 16Z DS
  • 3567146 (NDC: 57771-0001-05) — NANOVM POWD 275GM 9- 18DS
  • 3567153 (NDC: 57771-0001-04) — NANOVM T/F POWD 275GM DS
  • 3567161 (NDC: 57771-0001-09) — GALAXTRA POWD 375GM DS
  • 3567187 (NDC: 57771-0001-16) — CYTOLLINE POWD 275GM DS
  • 3567195 (NDC: 57771-0001-10) — CYTO CARN POWD 150GM DS
  • 3567203 (NDC: 57771-0001-11) — CYTO RALA POWD 30GM DS
  • 3567211 (NDC: 57771-0001-29) — PURECARB POWD 600GM DS
  • 3567229 (NDC: 57771-0001-31) — CHOLEXTRA T/F POWD 185GM DS
  • 3567237 (NDC: 57771-0001-33) — CHOLEXMAX POWD 75GM DS