CG-MED-08 Home Enteral Nutrition

This policy addresses home enteral nutrition, including oral medical foods and enteral tube feeding. Oral enteral nutrition is covered when the product is a medical food used to manage a specific disorder with distinctive nutritional requirements, provides more than 50% of total caloric intake, and the condition is an inborn error of metabolism (e.g., PKU, homocystinuria, methylmalonic acidemia) or a disorder affecting absorption/assimilation (e.g., documented milk/food allergy confirmed by formal challenge). Oral or tube enteral nutrition is not covered when these criteria are not met, when used for convenience or preference, or when requesting features beyond medical necessity (e.g., pre-packaged or liquid instead of powder).

"Oral enteral nutrition (oral feeding) is consideredmedically necessarywhenallof the following criteria are met:"

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