Medicare will cover Real Food Blends for enteral patients, but it is considered a special enteral formula (B4149) where medical necessity must be justified. Proof of trial and failure of standard formula must be submitted, including documentation of which formula(s) were trialed, when they were trialed, and evidence of patient’s intolerance response to formula. If a special enteral nutrition formula is provided and the medical record does not document why that item is medically necessary, it will be denied as not reasonable and necessary.

Standard Formula: Enteral formulas consisting of semi-synthetic intact protein/protein isolates (B4150 or B4152) are appropriate for the majority of beneficiaries requiring enteral nutrition.

Common documentation that supports coverage:

• Medical record
• Hospital discharge summary
• Speech therapy discharge summary
• Swallow study results
• Dietitian notes

It is important that the patient’s medical record explains their condition, the impairment that justifies the need for the tube feeding, and clearly explains why RFB is needed versus a different formula and the symptoms of intolerance that the patient experienced on other formulas.