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Nutrition and Reimbursement

Enteral nutrition reimbursement is reviewed on a case by case basis and requires specific documentation of medical conditions and proof of medical necessity. Enteral nutrition in the home setting is most often supplied by a durable medical equipment (DME) provider. Coverage guidelines will differ by insurance plan. Healthcare Professionals are encouraged to provide thorough letters of medical necessity and associated documentation in order to improve the likelihood of coverage for their patients.

Nestle provides tools to guide documentation of nutrition requirements and necessity. The Nestle Health Science Market Access team is available to provide information and assistance to enhance the likelihood of 3rd party payer coverage for medical nutrition therapies.

Reimbursement Resources

Accurate documentation of a patient’s condition and nutrition requirements is essential to securing health insurance coverage. Coverage requirements differ by insurance plan. Nestle has created Letters of Medical Necessity and a uniform Addendum to Letters of Medical Necessity to assist practitioners with proper documentation of nutrition claims.

Addendum to letter of Medical Necessity

Designed to identify specific elements of documentation to include when seeking enteral nutrition coverage for patients requiring enteral nutrition.

Letters of Medical Necessity

Product specific documentation that a HCP can use to guide drafting their own statement of medical justification on a patient’s condition that requires a Nestle enteral nutrition product. Please see coverage disclaimers on each document.

Reimbursement Support Program

The formula4success™ service recognizes that navigating the insurance benefit world can be challenging. This is a complimentary service offering personalized support to individuals with reimbursement questions regarding Nestlé enteral nutrition products.

Contact us at 844-283-0365

We can help you!

To request assistance from the Nestlé Market Access please call 1-800-422-ASK2(2752)

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