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Your Health . . . Our Concern . . . At Home Serving Connecticut for over 20 years Toll Free Phone: 1.888.575.7778 Toll Free Fax: 1.800.221.3003 |
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Your Health . . . Our Concern . . . At Home Serving Connecticut for over 20 years Toll Free Phone: 1.888.575.7778 Toll Free Fax: 1.800.221.3003 |
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Enteral Nutrition is covered under the Prosthetic Device Benefit for Medicare Part B. The patient receives nutrition support through a tube placed into the stomach or small intestines. The tubes may be Nasoenteric, Gastic or Jejunal. Enteral nutrition therapy must be ordered by a physician. The Patient Must Have: |
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| Patient's condition can be either anatomic OR due to a motility disorder. Below is a partial list of diagnosis codes that are likely, but not guaranteed, to qualify patients for coverage under Medicare Part B. When diagnosis itself does not reflect functional impairment, additional diagnosis may be required to qualify for coverage. | |||||||||||||||||||||||||||||||
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* 335.20 - ALS * 933.1 - Aspiration * 560.9 - Bowel or intestinal obstruction (unspecified) * 230.3 - Cancer - colon * 230.1 - Cancer - esophagus * 195.0 - Cancer - head, face, neck * 152.2 - Cancer - ileum * 152.1 - Cancer - jejunum * 231.0 - Cancer - larynx * 145.9 - Cancer - mouth, unspecified * 149.0 - Cancer - pharynx, unspecified * 152.9 - Cancer - small intestine * 230.2 - Carcinoma - stomach * 141.0 - Cancer - tongue, base * 141.9 - Cancer - tongue, unspecified * 231.1 - Cancer - trachea * 555.9 - Crohn's disease (unspecified) * 555.0 - 555.2 - Crohn's disease (more specific) * 780.01 - Coma * 428.0 - Congestive Heart Failure * 496 - COPD * 437.9 - CVA - cerebrovascular disease (unspecified) * 707.0 - Decubitus Ulcer (unspecified) * 707.1 - 707.7 - Decubitus Ulcer (more specific) * 250.0 - Diabetes Mellitus (Type II) * 250.1 - Diabetes Mellitus (Type I) |
* 558.9 - Diarrhea,
chronic (unspecified) * 564.2 - Dumping Syndrome * 787.23 - Dysphagia, pharyngeal phase * 438.12 - Dysphagia, late effect of CV disease * 530.3 - Esophageal stricture and stenosis * 579.8 - Fat malabsorption * 569.81 - Fistula of intestine * 536.3 - Gastroparesis * 357.0 - Guillain-Barre Syndrome * 042 - HIV/AIDS * 783.21 - Loss of weight * 579.9 - Malabsorption, unspecified * 557.0 - Mesenteric infarct * 340 - Multiple sclerosis * 564.81 - Neurogenic bowel * 537.3 - Obstruction of duodenum * 310.9 - Organic brain syndrome * 577.1 - Pancreatitis, chronic * 332.0 - Parkinson's disease * 780.03 - Persistent vegetative state * 262 - Protein calorie malnutrition, severe * 263.0 - Protein calorie malnutrition, moderate * 290.3 - Senile dementia * 579.3 - Short bowel syndrome * 432.1 - Subdural Hemotoma * 556.9 - Ulcerative colitis, unspecified * 290.40 - Vascular dementia, mutli-infarct |
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Use of formulas other than B4150 or B4152 requires documentation of Medical Necessity by Medicare. Justification for Medical Necessity is not diagnosis driven and may require supportive clinical laboratory information and/or clinical chart documentation to support justification for use and reimbursement. Enteral Nutrient HCPC Description
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Pumps may be used as a result of complications associated with the use of the gravity or syringe (bolus) methods of administration. Use of an enteral pump requires a secondary diagnosis to support the medical necessity. Common reasons why feeding
by gravity or syringe may not be acceptable: |
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