Enteral Nutrition (Oral and Tube Feeding) – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers enteral tube feeding only when InterQual® CP criteria are met and covers oral Specialized Nutrient Formulas (Medical Foods) only for specified chronic conditions (e.g., listed inborn errors of metabolism, CKD <24 months, Crohn’s, severe malabsorption, malnutrition risk, severe food allergies including EoE/FPIAP/FPIES, or pediatric GER with failure to thrive), while excluding standard/OTC formulas, blenderized/home formulas, commercial thickeners, electrolyte fluids, supplements, and formulas for mild/moderate food allergies. Coverage requires a prescription from a physician/advanced practitioner (NP, CNS, PA) or registered dietitian, documentation that the condition is chronic and not manageable by diet alone, evidence the product is a Medical Food, documentation of the qualifying diagnosis (and InterQual documentation for tube feeding), and verification of member-specific benefits and exclusions.

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