CG-MED-37 Intensive Programs for Pediatric Feeding Disorders

- Policy addresses evaluation and treatment (including intensive programs) for pediatric feeding disorders (PFD). - Medically necessary: an evaluation to confirm suspected PFD for children whose feeding difficulties began before age 5 and who either show impaired growth (significant weight loss/no weight gain over 2 months or crossing ≥2 major weight percentiles downward) or have met milestones only by relying on high‑calorie or nutritionally deficient foods and need transition to appropriate nutrition. - Not medically necessary: when these criteria are not met, including “picky/selective” eaters with normal growth; inpatient intensive programs except when facility-based care is required for acute complications (for example, malnutrition/failure to thrive, unstable electrolytes, serious food-allergy reactions, significant tube-to-oral transition issues); and duplicate therapy.

"Anevaluation*to confirm a suspected diagnosis of pediatric feeding disorder**is consideredmedically necessaryfor children whose difficulties beganunder five (5) years of agewho meeteitherof the fol..."