Enteral nutrition is covered under the Prosthetic Device benefit (Social Security Act § 1861(s)(8)). In order for a beneficiary's nutrition to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the National Coverage Determinations (NCD) Manual (CMS Pub. 100-03), Chapter 1, Section 180.2 must be met. In addition, there are specific regulatory, payment and coding requirements, discussed below, that also must be met. Enteral nutrition products that are administered orally and related supplies are noncovered; no benefit. If the coverage requirements for enteral nutrition are met, medically necessary nutrients, administration supplies and equipment are covered. Enteral nutrition provided to a beneficiary in a Part A covered stay must be billed by the Skilled Nursing Facility (SNF) to the A/B MAC. No payment from Part B is available when enteral nutrition services are furnished to a beneficiary in a stay covered by Part A. However, if the stay is not covered by Part A, enteral nutrition may be eligible for coverage under Part B and may be billed to the DME MAC, by either the SNF or an outside supplier.
Enteral Nutrients
