Pediatric Oral Function Therapy

Pediatric oral function therapy—therapeutic feeding and swallowing interventions—is covered for young children with pediatric feeding disorder/impaired oral intake (including ARFID), aspiration/penetration, neuromuscular or neurodevelopmental contributors (e.g., prematurity, hypotonia, autism), and for transitioning children from parenteral nutrition, gastrostomy feedings, or nutritionally inappropriate/high‑calorie diets to oral nutrition. Coverage is limited to children under five and requires documented failure to meet growth/developmental milestones or significant weight loss (or downward crossing of ≥2 major weight percentiles), prior adequate treatment of contributing medical conditions, an individualized measurable treatment plan, and compliance with specified continuation criteria.

"Anatomic or neurologic condition contributing to failure to meet developmental milestones of growth and development, plus either (a) reduction in weight or cessation of weight gain over the previou..."