Does B9004 require prior authorization?

No, B9004 does not require prior authorization (high confidence). Code is covered without prior authorization.

`B9004`, Parenteral nutrition infusion pump, portable

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

A completed Standard Written Order (SWO) must be communicated to the supplier before claim submission; for DMEPOS base items requiring WOPD, a signed WOPD must be received before delivery.
Medical records must document the clinical diagnosis, the consideration/attempt/contraindication of enteral nutrition, and permanence of the impairment (see Policy Article).
Treating practitioner evaluation within 30 days prior to initiation of parenteral nutrition must be documented, or the reason and alternate monitoring methods must be documented if not performed.
Document medical necessity when prescribing calories outside 20–35 kcal/kg/day, protein outside 0.8–2.0 g/kg/day, dextrose concentration <10%, or lipids above product-specific FDA dosing.

Parenteral nutrition is covered when the beneficiary qualifies under the Medicare Prosthetic Device Benefit and the service is reasonable and necessary for the diagnosis or treatment of illness or injury.
Parenteral nutrition is covered only when enteral nutrition (EN) has been considered and ruled out, tried and found ineffective, or EN exacerbates gastrointestinal tract dysfunction.
Beneficiary must have either (a) a condition of the small intestine and/or its exocrine glands that significantly impairs nutrient absorption or (b) disease of the stomach and/or intestine that is a motility disorder impairing transport and absorption of nutrients.
The beneficiary must have a permanent impairment causing the need for parenteral nutrition (see LCD-related Policy Article for permanence guidance).
Related supplies, equipment, and nutrients are covered when the coverage requirements for parenteral nutritional therapy are met under the prosthetic device benefit.
A daily total caloric intake of 20–35 kcal/kg/day is considered reasonable and necessary; medical necessity must be documented if prescribing calories outside this range.

ANTHEM-CG-MED-89, CG-MED-89 Home Parenteral Nutrition

L38953, Parenteral Nutrition

AMBETTER-CP.MP.163, Total Parenteral Nutrition and Intradialytic Parenteral Nutrition

MED201.011, Nutritional Support

BCBSIL-MED201.011, Nutritional Support

Ask Verity about documentation requirements, denial risks, or coverage in your state.