Tube Feeding and Oral Nutrition Supplies: Medicaid vs. Medicare
If you or a loved one needs feeding supplies, Finnegan Health Services has a wide range of products covered by Arkansas Medicaid, Medicare, and some private insurances. We offer feeding pumps, feeding tubes, supply kits (pump, gravity bags, syringes, etc), IV Poles if necessary, and a wide range of medically specialized formulas. And while not for nutrition, we also offer Liquid and Food Thickeners for swallowing issues, like Dysphagia. These supplies are also covered by your insurance with a proper diagnosis.
What does Arkansas Medicaid Cover?
For a child 5 to 18 years old, there is no dollar limit to what Medicaid will cover, but the patient’s prescription limit is 3,000 calories or 30 units of formula per day. The prescribing PCP will determine the amount of nutrition needed. If the child is drinking the formula by mouth and not by tube, Medicaid requires EPSDT, or Well-Child, visits almost annually. These visits are a general check-up by a pediatrician.
While Finnegan Health Services already has an Enteral Prescription form HERE, if you send us a prescription, please make sure it contains the following (required):
-PCP must sign the prescription. A dietician or surgeon’s signature will not be valid.
-Prescription must contain the caloric need or cans per day needed by the patient
-Acceptable medical diagnosis (see below)
-For thickener, prescription must include frequency or dose and amount of dose
For an adult, Medicaid does not cover oral nutrition but instead, only covers tube feeding supplies. Tube-fed patients on Medicaid require a PA, or Prior Authorization, before being approved. Finnegan Health Services will handle all of this paperwork for you.
What does Medicare Cover?
Please note: Medicare does not cover any nutrition taken by mouth. On Medicare, the patient must be tube-fed for coverage. Medicare does cover Enteral Nutrition but never Oral Nutrition.
The rules for Medicare are different than for Medicaid. The patient must have both Medicare Part A and Part B to be eligible. The patient must be tube-fed and have a diagnosis of significant impairment of the GI, or Gastro-Intestinal, tract.
Medicare requires updated records every year and the patient must have the diagnosis for 3 months. On the prescription, the doctor must list the daily caloric intake, the type of feeding tube needed, all extra supplies such as syringes, gravity bags, IV pole, etc.
If you have private insurance, your tube-feeding needs are approved on a case by case basis by your insurance company. Finnegan Health Services works hard to have all of our patients’ needs covered but sometimes our hands are tied by the insurance company’s rules.
MEDICAID Commonly Accepted Diagnoses Codes
Other diagnoses that are not listed below may be accepted. Give us a call at 501-663-6600 or email wecare@finneganhealth.com to find out if your patient or loved one’s diagnoses is covered.
63.4 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 assymetry
F50.9 Eating Disorder, unspecified
R62.51 Failure to thrive (child)
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 Gastronomy status
E44.0 Moderate protein-calorie malnutrition
R11.2 Nausea with vomiting, unspecified
K91.2 Postsurgical malabsorption, not elsewhere classified
R63.6 Underweight
E46 Unspecified protein-calorie malnutrition
E63.9 Nutritional deficiency, unspecified
E41 Nutritional marasmus
MEDICARE Commonly Accepted Diagnoses
Other diagnoses that are not listed below may be accepted. Give us a call at 501-663-6600 or email wecare@finneganhealth.com to find out if your patient or loved one’s diagnoses is covered.
- Alzheimer’s disease
- Amyotrophic lateral sclerosis
- Aneurysm
- Anoxic encephalopathy
- Bowel Infarction
- Cancer of any part of the upper GI Tract
- Cerebral Palsy
- Cerebrovascular accident (CVA)
- Closed Head injury
- Comatose
- Degenerative Brain Disease
- Duodenal Obstruction (J tube only)
- Encephalopathy
- Esophageal obstruction
- Esophageal paralysis
- Esophageal perforation
- Gastrectomy – total or partial(J tube only)
- Gastric outlet obstruction (J tube only)
- Gastrointestinal hemorrhage
- Guillain-Barre syndrome
- Hepatic Encephalopathy
- Multi-infarct Dementia
- Quadriparesis
- Senile dementia
Finnegan Health Services is here to answer any and all questions about Enteral and Oral Nutrition supplies. Please call us today at 501-663-6600 or email wecare@finneganhealth.com and one of our Customer Service Representatives will be happy to help.
We also have sales representatives covering the entire state of Arkansas. If you would like an educational in-service about Nutrition or any of the products Medicaid cover, we are happy to set up an appointment.
Finnegan Health Services has been serving Little Rock since 1984 and Statewide in Arkansas since 1991. We ship statewide for FREE and always have. Our customers receive the best service and they are happy to share their reviews. Please call us with your questions today!
” 5 stars. I would highly recommend. Great service. Friendly people. AAA+++”
– Patient
