Parenteral Nutrition

Parenteral nutrition is covered under the Prosthetic Device benefit when it is reasonable and necessary and the beneficiary has a long and indefinite impairment causing significant malabsorption (eg, small intestine/exocrine gland impairment or stomach/intestine motility disorder), with the treating practitioner documenting permanence and justification. Coverage requires specified documentation (detailed medical record, treating practitioner's judgment), compliance with Final Rule 1713 face-to-face and WOPD requirements for specified HCPCS codes, and adherence to billing rules (one pump per beneficiary, one supply/admin kit per day, specific unit-of-service rules and required modifiers); DIF/CMN requirements were removed for dates of service on/after 2023-01-01.

"Parenteral nutrition is covered when it meets the reasonable and necessary requirements of the related LCD and is provided under the Prosthetic Device benefit (Social Security Act §1861(s)(8))."