Last year, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators temporarily suspended the precertification requirement for nutritional formulas and enteral nutrition in support of members who may have been affected by the nationwide powder infant formula shortage.
This suspension of precertification has been extended to February 28, 2023.
Since the situation continues to improve, effective March 1, 2023, the precertification requirement for nutritional formulas and enteral nutrition will resume for the following HCPCS codes:
- B4149
- B4150
- B4152
- B4153
- B4154
- B4155
- B4158
- B4159
- B4160
- B4161
For detailed policy information, refer to #08.00.18o: Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk.