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This notification is to clarify that for IBC commercial members, medical
foods, low-protein modified food products, enteral nutrition, and nutritional
formulas (collectively "Medical Foods") have a separately identifiable benefit
category and member
cost-sharing associated with this service. When verifying a member's coverage
for Medical Foods, please be clear that you are inquiring about the member's
Medical Foods benefit. Note: Medical Foods require precertification.
While Medical Foods will be covered pursuant to its own benefit category,
supplies utilized during the administration of Medical Foods (e.g., tubing,
pumps) are eligible for coverage under the member?s durable medical equipment
(DME) benefit. Therefore applicable DME cost-sharing would be applied to
these supplies.
For additional information on these services, please refer to Medical Policy
#08.00.18i: Medical Foods, Low-Protein Modified Food Products, Enteral
Nutrition, and Nutritional Formulas. You can find this policy by going to our
Medical Policy Portal, selecting
Accept and Go to Medical Policy Online, and typing the policy name or
number in the Search box.
]