Enteral Nutrition - Policy Article
A58833
Enteral nutrition is covered under the Prosthetic Device benefit when reasonable and necessary per the related LCD, the treating practitioner documents a long and indefinite impairment (test of permanence), and records show full/partial non-function of structures that permit food to reach the small bowel or disease impairing small bowel digestion/absorption. Specialty formulas require documentation that standard formulas are inadequate, face-to-face encounters and a Written Order Prior to Delivery (WOPD) are required for specified HCPCS codes, and many products (oral nutrition, blenderized grocery items, electrolyte fluids, self-blenderized formulas) are specifically non-covered. Supply units are limited (one UOS per day for listed supply codes), and DIF/CMN requirements changed as of Jan 1, 2023 (no longer required to be submitted for services on/after that date).
"Enteral nutrition is covered under the Prosthetic Device benefit when the service is reasonable and necessary per the related Local Coverage Determination (LCD) and all Medicare statutory and regul..."