Independence will issue a new medical policy to communicate the coverage criteria for precertification of pediatric intensive day feeding programs. Medical Policy #10.00.03: Pediatric Intensive Day Feeding Program was posted as a Notification on December 28, 2018 and will go into effect January 28, 2019.
Pediatric intensive day feeding programs for treatment of a feeding disorder are offered in an outpatient setting. These programs are provided when the individual requires the intensity of acute inpatient rehabilitation but does not require 24-hour-a-day medical and nursing supervision provided in that setting. Treatment of a feeding disorder occurs during each weekday; the individual returns home each evening and for the entire weekend.
Treatment of a feeding disorder in a pediatric intensive day feeding program involves multiple therapeutic services overseen by a physician who is part of a multidisciplinary professional team. The team may be comprised of a combination of behavioral therapist, occupational therapist, physician, registered dietitian, and speech language pathologist/therapist. A component of pediatric intensive day feeding programs may include other medical services such as psychological therapy, nursing, and case management.
Feeding disorder treatment in an outpatient pediatric intensive day feeding program is considered medically necessary and, therefore is covered when the criteria outlined in the medical policy are met.
To obtain precertification, providers should call Clinical Services at 1-800-ASK-BLUE and select Authorizations from the menu. Initial authorizations for pediatric intensive day feeding cannot be submitted through the NaviNet® web portal at this time.
To view the Notification for this policy, visit our Medical Policy Portal select Accept and Go to Medical Policy Online, and then select Commercial under Active Notifications.
If you have additional questions, please contact Provider Services at 1-800-ASK-BLUE.
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