Both enteral and parenteral nutrition are included in the prosthetic device benefit provision of Part B of Medicare, which covers items that replace an organ or perform the function of a permanently inoperative or malfunctioning organ. The benefit covers supplies, equipment, and nutrients (Medicare defines permanent as more than 90 days).
The patient must have a permanent inability to permit food to reach or be absorbed from the small intestine (Medicare considers the test of permanence to be three months or more or at least the anticipation of three months or more of therapy).
- Coverage is possible for patients with partial impairment who can eat small amounts of food but need tube feedings to maintain their weight and nutritional status—for example, a patient with Crohn’s disease who is able to eat some food but needs prolonged tube feeding to overcome his or her problem with absorption.
- Some common situations that are not covered by Medicare are patients who need enteral nutrition due to anorexia, nausea, or an end-stage disease but have a functioning GI tract and no obstruction or malabsorption problems.
Nutrition products taken orally are not covered by Medicare.
Does not need to be the sole source of nutrition.
Regular grocery products which can be mixed in a blender are considered food rather than a food supplement and are not covered.
Enteral nutrition supplies & equipment (feeding pump) – Medicare.gov