Enteral Nutrition

Medicare covers enteral nutrition when a beneficiary requires enteral access feedings to maintain adequate nutrition and has a permanent non-function of structures that permit oral intake or a disease impairing small-bowel digestion/absorption, and when adequate nutrition cannot be achieved by oral means. Coverage of specific formulas, pumps, in-line enzyme cartridges, feeding kits, and supplies is subject to medical necessity documentation, correspondence with administration method, coding guidelines, proof of delivery, and specified quantity/frequency limits (e.g., ≤2 enzyme cartridges/day; ≤3 nasogastric tubes/3 months; ≤1 gastrostomy/jejunostomy tube/3 months).

"Enteral nutrition is covered when a beneficiary requires feedings via an enteral access device to provide sufficient nutrients to maintain weight and strength commensurate with overall health and h..."