Local Coverage Determination · DME MAC
L38955
Enteral Nutrition
Version 24. CMS effective date 01/01/2024. CMS updated 12/07/2023. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Enteral nutrition is covered for a beneficiary who requires feedings via an enteral access device to provide sufficient nutrients to maintain weight and strength commensurate with the beneficiary's overall health status and has a permanent: full or partial non-function or disease of the structures that normally permit food to reach the small bowel; OR, disease that impairs digestion and/or absorption of an oral diet, directly or indirectly, by the small bowel. Refer to the LCD-related Policy Article for the definition of test of permanence. Adequate nutrition must not be possible by dietary adjustment and/or oral supplements.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A58833 · Enteral Nutrition - Policy Article
- A59397 · Response to Comments: Enteral Nutrition - DL38955
HCPCS codes on this LCD
28 other Level II codes are on the LCD and are not given a page in this set: B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4100, B4102, B4103, B4104, B4105, B4148, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, B9998.
Questions
What does LCD L38955 cover?
L38955 is Enteral Nutrition. It is a current final DME MAC local coverage determination, version 24.
Where is the CMS source for L38955?
The Medicare Coverage Database page for LCD L38955 version 24.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A9270&as_of=2024-01-15&npi=1234567890&state=UT"