Change in payment for enteral feedings

Enteral nutritional therapy (S9340) is no longer covered for pre-mixed formula, such as Ensure.  By definition, code S9340 is: Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem. 

Effective immediately, S9340 will process as not covered.

Rationale

This code was intended to be used for pharmacy services and supplies provided by home infusion providers only for custom formulas. However, this code has been overused and is frequently billed inappropriately, including billing for pre-mixed formulas like Ensure.

Coverage process

Custom formulas will be evaluated for payment of the per diem retrospectively upon request when you submit documentation of customization post payment. 

Formula and supplies related to enteral feedings should be billed using the appropriate "A" and "B" codes.

Questions?

See the Enteral Nutritional Therapy medical policy 91278 for additional information.

Also see the Enteral Formulas Prior Authorization form.