Home Enteral Nutrition Therapy – Administrative Information

Special Considerations

• Providers should be in compliance with the American Society for Parenteral and Enteral Nutrition (ASPEN) standards for home nutrition support.
• In the event of an unexpected discontinuation of therapy, payment will be provided for up to a 30-day supply of previously dispensed enteral nutrition solution.

Claims Filing Information

Please use the codes listed below when submitting claims for enteral therapy.

Note: B9998 should be used only if the specific B code for the Enteral formula does not exist. This code does not provide sufficient information for HMSA to determine the appropriate payment, resulting in a discounted percentage of the current AWP.

Nursing services (CPT codes 99601 and 99602) are covered and do not require precertification. Nursing services may be billed separately and are not included in the per diem for IV therapy.

To view the policy: Home (Enteral) Nutrition Therapy [PDF]

*Effective 7/1/15, payment for enteral therapy services rendered in a Skilled Nursing Facility (SNF) is NOT included in the daily per diem reimbursement amount to the SNF during covered SNF days and will be reimbursed separately (the member’s plan benefit will be applied).

Please be sure to use the most up-to-date industry-standard procedure, revenue, and diagnosis codes from the current CPT®, HCPCS Level II, and ICD-10-CM manuals, as recommended by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and the American Hospital Association (AHA).

• Codes may not be all inclusive as the AMA and CMS code updates may occur frequently

Revision History