enterade® may be eligible for reimbursement from health insurance plans if they cover medical foods and when prescribed for a medical need*
Coverage depends on the insurance provider and plan.
As the manufacturer, Enterade cannot bill insurance directly.
*Must be used to treat a medical condition and be prescribed by a licensed healthcare professional to treat an illness or condition
To check if enterade is covered by your insurance plan, follow the steps below:
1.
Call your insurance carrier
Patient calls member services line or provider calls provider line and lets them know enterade is ordered and calling to check if it is covered.
2.
Provide the NDC code
to the insurance carrier
Enterade® AO Vanilla
NDC Code 28028-0353-89
Enterade® AO Orange
NDC Code 99422-0992-48
Enterade® AO Mixed Berry
NDC Code 60008-0321-13
Enterade® AO Watermelon
NDC Code 60008-0321-12
3.
Insurance Carrier will let the Patient Know if enterade is Covered
4.
IF COVERED:
Ask what they need: prescription, clinical notes, and/or letter of medical necessity
5.
If No Pharmacy Nearby…
Ask if you can purchase product directly from manufacturer and submit for reimbursement with a claim form
If enterade is covered, obtain a prescription from a physician or a health care provider.
1.
The Rx Needs to Include Patient’s Name,
Date of Birth, & Diagnosis
2.
Sample Rx
enterade 2x/day x 30 days plus 2 refills
(allows for usage throughout treatment)
3.
Needs to Include Diagnosis/Reimbursement Codes
(ICD 10)
Code Examples:
a. Leaky gut syndrome: K59.9
b. Diarrhea: R19.7
c. Electrolyte imbalance: E87.8
d. Colostomy status: Z93.3
e. Dehydration: E86.0
f. Short gut syndrome: K91.2
g. Ileostomy status: Z93.2
h. Irritable bowel syndrome: K58.9
i. Mucositis (ulcerative): K12.3
If Prior Authorization is Required, Follow These Steps:
1.
Submit clinical notes
Anything nutrition related to Oncology or GI
For Flexible Spending/Health Spending Accounts
enterade is covered by FSA/HSA if used to treat a medical condition and prescribed by a licensed healthcare professional
1.
Obtain a Rx for enterade as outlined above
sample Rx:
enterade 2x/day x 30 days plus 2 refills
(allows for usage throughout treatment)
2.
3.
Submit to your FSA Carrier for Reimbursement
Submit prescription & a copy of your receipt
For Pharmacy or DME Use Only
Must be a pharmacy/DME that carries enterade
1.
Patient must have a prescription for Enterade
2.
Bill with HCPCS or NDC Code
Enterade® AO Vanilla
HCPCS Code B4102 (Adults) , B4103 (Pediatrics)
NDC Code 28028-0353-89
Enterade® AO Orange
HCPCS Code B4102 (Adults) , B4103 (Pediatrics)
NDC Code 99422-0992-48
Enterade® AO Mixed Berry
HCPCS Code B4102 (Adults) , B4103 (Pediatrics)
NDC Code 60008-0321-13
Enterade® AO Watermelon
HCPCS Code B4102 (Adults) , B4103 (Pediatrics)
NDC Code 60008-0321-12
