Effective for dates of service (DOS) on and after April 1, 2020, ForwardHealth introduces new coverage policy for enteral nutrition formula and enteral feeding supplies to improve and increase member access and to reduce administrative burden to providers through the following changes:

• Prior authorization (PA) for enteral nutrition formula will be approved in real time when submitted on the ForwardHealth Portal for members who receive all nutrition administered through a gastric or jejunostomy tube.
• For all PA submission types, the Healthcare Common Procedure Coding System (HCPCS) code for enteral nutrition formula will be approved, not the specific enteral nutrition formula brand name.
• Coverage for enteral nutrition formula consumed orally has been expanded for members with diagnoses of failure to thrive, malnutrition, and/or inborn errors of metabolism.
• Coverage for enteral nutrition formula consumed orally and for members transitioning from tube feeding to an oral diet has been expanded. Requests will be reviewed on an individual basis and will not be subject to predetermined quantity or time limitations.
• Coverage of syringe-fed enteral feeding supply kits will be added.

The full update is available online (link).