Which criterion qualifies a patient for home enteral nutrition (HEN) under Medicare?

Which criterion qualifies a patient for home enteral nutrition (HEN) under Medicare?

• A. A permanent non-function or disease of the structures that normally permit food to reach the small bowel
• B. A temporary impairment of the mouth that prevents food from reaching the small bowel
• C. A desire to start tube feeding
• D. A disease of the stomach that impairs digestion

Answer: (A)

Medicare coverage for home enteral nutrition hinges on whether the GI tract can no longer function to deliver nutrition. The qualifying criterion is a permanent non-function or disease of the structures that normally permit food to reach the small bowel, meaning the pathway from the mouth through the upper GI tract is irreversibly impaired and oral intake can’t meet nutritional needs. When the impairment is temporary, such as a short-term mouth issue, or when there’s only a desire to start tube feeding, or a stomach disease that impairs digestion but doesn’t permanently block nutrient delivery to the small bowel, HEN typically isn’t Medicare-qualifying.

Medicare coverage for home enteral nutrition hinges on whether the GI tract can no longer function to deliver nutrition. The qualifying criterion is a permanent non-function or disease of the structures that normally permit food to reach the small bowel, meaning the pathway from the mouth through the upper GI tract is irreversibly impaired and oral intake can’t meet nutritional needs. When the impairment is temporary, such as a short-term mouth issue, or when there’s only a desire to start tube feeding, or a stomach disease that impairs digestion but doesn’t permanently block nutrient delivery to the small bowel, HEN typically isn’t Medicare-qualifying.