CG-MED-99 Intradialytic Parenteral Nutrition

This policy addresses intradialytic parenteral nutrition (IDPN), the intravenous delivery of nutrition during hemo- or peritoneal dialysis. Anthem deems IDPN not medically necessary for all indications and therefore not covered. Non-coverage applies regardless of diagnosis or clinical circumstances and includes related HCPCS codes B4164–B4222 (commonly billed with ICD-10 codes such as N17.0, N17.9, N18.6, Z99.2).

"Intradialytic parenteral nutrition is considerednot medically necessaryfor all indications."

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