The Centers for Medicare & Medicaid Services (CMS) is reminding suppliers and practitioners how to correctly document and bill for parenteral nutrition.
The Medicare Learning Network (MLN) Connects newsletter for Oct. 22 noted the improper payment rate for parenteral nutrition was 33% as reported in the 2024 Medicare Fee for Service Supplemental Improper Payment Data. CMS projected the resulting improper payment amount at $81.9 million.
Insufficient documentation was the cause of 69.4% of improper payments during the 2024 reporting period. Other denial reasons included medical necessity (9.5%), no documentation (1.3%), and incorrect coding (0.1%). Other errors — described as duplicate payments, non-covered or unallowable service, or a patient not qualifying for Medicare coverage — made up 19.4% of improper payments.
The MLN article noted that Medicare covers one infusion pump (HCPCS codes B9004 and B9006), and typically covers parenteral therapy nutrition solutions, with refills no earlier than 30 days before the end of the current supply.
Practitioners ordering parenteral nutrition need to write an order or prescription with medical documentation to meet Medicare’s prosthetic device benefit requirements. The order or prescription must also demonstrate that parenteral nutrition is medically necessary.
Documentation must rule out enteral nutrition. Parenteral nutrition patients must have “a condition involving the small intestine, its exocrine glands, or both, that significantly impairs absorbing nutrients or have a disease of the stomach, intestine, or both, that’s a motility disorder and impairs the ability of nutrients to be transported through and absorbed by the gastrointestinal system.” Patients must also have permanent impairment of “long and indefinite duration.”
