www.FinneganHealth.com | 1-888-789-6600

Enteral and Oral NutritionArkansas Medicaid Coverage Guidelines

Enteral and Oral Feeding Supplies are Covered

• Child must be 5-21 years old

• No dollar limit but maxed at 30 units/3,000 calories per day

• Quantity determined by Prescribed Caloric Need

• PA (Prior Authorization) is required for tube feeding every 6 months

• Medical Records are required yearly

What Diagnoses are Accepted by Medicaid?For Enteral Feeding and Nutrition, Medicaid accepts ICD-10 DX of, or similar to:

R63.4 Abnormal weight loss Z91.011 Allergy to milk products R63.0 Anorexia Z68.51 BMI pediatric, less than 5th percentile for age Q67.0 Congenital facial asymmetry F50.9 Eating disorder, unspecified R62.51 Failure to thrive (child)

What Diagnoses are Accepted by Medicaid?For Enteral Feeding and Nutrition, Medicaid accepts ICD-10 DX of, or similar to:

R63.3 Feeding difficulties K21.0 Gastro-esophageal reflux disease with esophagitis K21.9 Gastro-esophageal reflux disease without esophagitis K92.2 Gastrointestinal hemorrhage, unspecified Z93.1 Gastrostomy status E44.0 Moderate protein-calorie malnutrition R11.2 Nausea with vomiting, unspecified

What Diagnoses are Accepted by Medicaid?For Enteral Feeding and Nutrition, Medicaid accepts ICD-10 DX of or similar to:

K91.2 Postsurgical malabsorption, not elsewhere classified R63.6 Underweight E46 Unspecified protein-calorie malnutrition E63.9 Nutritional deficiency, unspecified E41 Nutritional marasmus

What is Required on the Rx?

PCP MUST SIGN RX- surgeon or dietician is not acceptable

Rx must include:

Caloric Need Daily or Cans per Day- Max is 3,000 calories or 30 cans

Arkansas Medicaid will accept reasonable medical diagnoses

Secondary or Tertiary diagnoses may be required though not likely

A Note on Liquid and Food Thickeners

• Thickeners to treat Dysphagia, or Swallowing Difficulties

• Not subject to dollar limits but limited to 16 units per date of service

• Acceptable ICD-10 DXs: All forms of Dysphagia or Risk of Aspiration

• RX must include Frequency of taking Thickener & amount required per instance

Finnegan Health Ships to your Patient FREE

Enteral Feeding and Nutrition supplies-- picked up or shipped monthly

Shipping is 100% FREE to your patient but is NOT covered by Medicaid

www.FinneganHealth.com | 1-888-789-6600

Thank You.