Harvard Pilgrim has updated our commercial Formulas and Enteral Nutrition Medical Review Criteria. The updated policy makes a distinction between oral administration and tube administration of low-protein foods, special medical formulas, and enteral nutrition, and outlines the separate coverage criteria for the two administration methods. In addition, enteral electrolyte hydration fluids and Relizorb have been added to the list of coverage exclusions.
Harvard Pilgrim has also added the following enteral formula codes to the policy, and they will now be eligible for coverage, with prior authorization: B4157; B4158; B4159; B4160; B4161; and B4162.
For complete information, please refer to Harvard Pilgrim’s updated Formulas and Enteral Nutrition Medical Review Criteria.