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® IBS-D Mixed Berry

NDC Code 60008-0321-11

 

-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

-3-

Needs to Include Diagnosis/Reimbursement Codes (ICD 10)

Code Examples: 

a. Irritable bowel syndrome: K58.9
b. Diarrhea: R19.7
c. Electrolyte imbalance: E87.8
e. Dehydration: E86.0
h. Leaky gut syndrome: K59.9

If Prior Authorization is Required, Follow These Steps:

 

-1-

Submit clinical notes

Anything nutrition related to Oncology or GI

-2-

Complete Letter of Medical Necessity

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

-2-

Purchase Product

on enterade.com, amazon, or at a pharmacy that carries it.

-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® IBS-D Mixed Berry

HCPCS Code B4102 (Adults) , B4103 (Pediatrics)

NDC Code 60008-0321-11