Billing Instructions - Parenteral and Enteral Nutrition - JA DME

Joint DME MAC Article
Posted on November 17, 2022

Effective for claims with dates of service on or after January 1, 2023, the DME MAC Information Form (DIF) for Parenteral and Enteral Nutrition is eliminated. The DIF required information about the number of calories per day ordered by the treating practitioner (Question 4). With the DIF elimination, suppliers will now need to calculate the units of service (UOS) for each enteral and parenteral product billed to Medicare, based on the treating practitioner’s order.

Enteral Example:
Order: Treating practitioner orders 2,000 calories per day of HCPCS code B4150.
Calculation: For code B4150, 1 UOS = 100 calories. 2,000 calories per day ÷ 100 calories per UOS = 20 UOS per day x 30 days = 600 UOS. If the supplier delivers 700 UOS instead of 600 UOS for convenience or due to beneficiary request, only the 600 UOS should be reported as the reasonable and necessary UOS on the claim. The excess units of service may be billed using the upgrade process as follows:

With an Advance Beneficiary Notice (ABN):
If the supplier wants to collect payment for the excess quantity, and obtained a properly completed ABN:
Line 1 - B4150GA 700 UOS, 30-day date span (total UOS delivered)
Line 2 - B4150GK 600 UOS, 30-day date span (reasonable and necessary UOS)

In this example, the claim line billed with GK would be eligible for payment when the coverage criteria are met and the line submitted with the GA modifier would be denied as not reasonable and necessary. The beneficiary liability would be the difference between the submitted charge for the GA line and the GK line plus any applicable deductible and co-insurance.

Without an Advance Beneficiary Notice (ABN):
If the supplier does not want to collect payment for the excess quantity or has not obtained a properly completed ABN:
Line 1 - B4150GL 600 UOS, 30-day date span (reasonable and necessary UOS)

In this example, the claim line billed with GL would be eligible for payment if the coverage criteria are met. The GL modifier identifies that a higher quantity UOS were provided than billed on the claim.

As a reminder, enteral feeding supply allowances (B4034, B4035, and B4036) must correspond with the method of enteral nutrition administration (syringe, pump, gravity). While the DIF required the method of administration details (Question 5), the requirement that feeding supplies must correspond with the enteral nutrition administration method remains unchanged with its elimination.

When enteral nutrition is being administered via a pump and the pump is beneficiary-owned, a narrative must be included on the claims for the enteral nutrition and supplies, indicating the HCPCS code of the pump, the date the beneficiary obtained the pump, and an indication of it being beneficiary-owned (e.g., include "OWN" in the narrative).

Refer to the Parenteral and Enteral Local Coverage Determinations (LCD) and related Policy Articles (PA) for additional information for which these instructions apply.

Publication History