Enteral and Parenteral Nutrition - JA DME
Enteral and Parenteral Nutrition
CMS Discontinuing CMNs and DIFs
Effective for Dates of Service on or after January 1, 2023
Coverage
- Enteral and Parenteral Nutritional Therapy National Coverage Determination (NCD)
- Enteral Nutrition - Correct Coding and Billing
- Parenteral Nutrition - Correct Coding and Billing
- Enteral Nutrition Local Coverage Determination (LCD)
- Enteral Nutrition Policy Article
- Parenteral Nutrition Local Coverage Determination (LCD)
- Parenteral Nutrition Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist - Enteral Nutrition [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Checklist - Parenteral Nutrition [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - CERT Enteral Nutrition [PDF] - Letter may be sent to clinicians regarding enteral nutrition documentation
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to help obtain documentation
- CMS 10126 DME Information Form (DIF) - Enteral/Parenteral Nutrition DIF (Required for dates of service prior to January 1, 2023 only)
- Enteral Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
- Parenteral Nutrition Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
Topic | Details |
---|---|
Accessories |
|
Billing |
Note: DIFs are required for dates of service prior to January 1, 2023 only |
Formula |
|
Kits |
|
Parenteral/Enteral Nutrition (PEN ) Therapy Payment Categories |
|
Pumps |
|
Upgrades
Scenario | Formula Listed on Standard Written Order (SWO) | Formula Listed on DIF |
---|---|---|
Physician Orders Specialty Formula | Specialty Formula | Standard Formula |
Physician Orders Standard Formula Beneficiary Requesting Specialty Formula | Standard Formula | Standard Formula |
Physician Orders Standard Formula Specialty Formula Requested for Convenience | Standard Formula | Standard Formula |
Last Updated Thu, 29 Dec 2022 19:13:16 +0000
Related Articles
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.