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Reimbursement

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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

-2-

Complete Letter of Medical Necessity

Download Here

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

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