If two enteral nutrition products, which are described by the same HCPCS code, are being provided at the same time, they should be billed on a single claim line with the units of service reflecting the total calories of both nutrients.

When multiple products are billed, submit a separate DIF for each line item with the answer to questions 3A (HCPCS) and 4A (calories per day) corresponding to the individual line item on the claim.

If the coverage requirements for enteral nutrition are met, medically necessary nutrients, administration supplies and equipment are covered.

It is possible for Medicare to have a DIF on file that contains different information than the most current DIF in the supplier records. This could result in payments that are not in the amount expected by the supplier.  It is imperative that suppliers keep current on DIF submission to properly reflect the current provision of nutrition.

Enteral formulas consisting of semi-synthetic intact protein/protein isolates (B4150 or B4152) are appropriate for the majority of beneficiaries requiring enteral nutrition.

For special enteral formulas (B4149, B4153-B4157, B4161, and B4162) the medical necessity will need to be justified for each beneficiary as to why this special formula is needed versus the semi-synthetic enteral formula.