WIC & Medicaid Pediatric Enteral Nutrition Formula Coverage

Requires State Medical Documentation Form. State Approval Subject to Change.

The reimbursement information contained in this publication is gathered from third party sources and is presented for illustrative purposes only. Nestlé HealthCare Nutrition assumes no liability or responsibility for the results or consequences of any actions taken in reliance on the information provided in this document. Billing entities should contact their third-party payers for specific information on their coding, coverage and payment policies. All medical necessity determinations must be made by the responsible clinician(s). The person or entity submitting claims for reimbursement is solely responsible for ensuring the appropriate filing and accurate content of any particular claim.
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