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Enteral Nutrition - Policy Article
Article A58833 · 5 versions, 2021 to today · last changed 2023-10-01 (R4)
Version 17 of Article A58833: in force by CMS's dates 2023-10-01 onward. The policy text on this page comes from this archived version.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
source
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CMS's newest revision note (R4, 2023-10-01), quoted
Revision Effective Date: 10/01/2023 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: “B4148” to supply allowance codes CODING GUIDELINES: Added: “B4148” to supply allowance codes 11/09/2023: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
source
This quote comes from CMS's revision-history file, not from the version's own file: Our archived file.
Sections in this version: Article Text. Plus 4 sections marked N/A in this version.
ICD-10-CM Codes that Support Medical Necessity (21 codes)
Group 1: 21 codes. CMS's group paragraph, quoted
The presence of an ICD-10 code listed in this section is not sufficient by itself to assure coverage. Refer to the section on "Coverage Indications, Limitations, and/or Medical Necessity" for other coverage criteria and payment information.
For HCPCS code B4105:
ICD-10-CM Codes that DO NOT Support Medical Necessity (CMS lists no codes)
Group 1: CMS lists no codes in this group. CMS's group paragraph, quoted
For the specific HCPCS code indicated above, all ICD-10 codes that are not specified in the previous section.
For all other HCPCS codes, ICD-10 codes are not specified.
CMS's list for version 17. The full code table serves customers with an API key.
source
CMS's ICD-10-CM lists in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.
Full verbatim text serves to customers · Customer? Log in
Version history, Article A58833
CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.
Revision history, every version
CMS's own change log, quoted, 4 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R4 · 2023-10-01 · v17
Revision Effective Date: 10/01/2023 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: “B4148” to supply allowance codes CODING GUIDELINES: Added: “B4148” to supply allowance codes 11/09/2023: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R3 · 2023-07-02 · v15
Revision Effective Date: 07/02/2023 MODIFIERS: Added: Section header Added: BA, BO, GA, GY, GZ, and KX modifier instructions Added: “As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner’s order.” Added: “Claim lines billed with codes without a KX, GA, GY or GZ modifier will be rejected as missing information” for claims with dates of service on or after July 2, 2023 CODING GUIDELINES: Removed: “As of January 1, 2023, suppliers must calculate the units of service (UOS) for each enteral product billed to Medicare, based on the treating practitioner’s order.” Removed: BA and BO modifier instructions 05/18/2023: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R2 · 2023-01-01 · v11
Revision Effective Date: 01/01/2023 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Billing information relevant to DIFs, for DOS affected by the DIF elimination CODING GUIDELINES: Added: Information pertaining to the need for calculation of UOS based on the treating practitioner’s order 11/17/2022: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R1 · 2021-09-05 · v7
Revision Effective Date: 09/05/2021 REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217): Removed: “The link will be located here once it is available.” Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list 04/14/2022: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
Receipts for auditors
Version 17 of Article A58833, shown on this page: in force by CMS's dates 2023-10-01 onward. Archived 2026-09-26. CMS's copy · Our archived file. 5 of 5 sections are proven word-identical to the archived file.
Every archived version of Article A58833 (5 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| Article A58833 | version 3 | 2021-09-05, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A58833 | version 7 | 2021-09-05 to 2022-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A58833 | version 11 | 2023-01-01 to 2023-07-01 | 2026-09-26 | CMS's copy · Our archived file |
| Article A58833 | version 15 | 2023-07-02 to 2023-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A58833 | version 17 shown | 2023-10-01 to today | 2026-09-26 | CMS's copy · Our archived file |
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