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

Title

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

Title

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

Title

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

Download Here
Title

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.

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

Title

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