Does S9340 require prior authorization?

No, S9340 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S9340?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S9340`, Home therapy; enteral nutrition; administrative services, professional pharmacy

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Electrocardiogram (ECG) results to identify cardiac abnormalities (sinus bradycardia, signs of hypokalemia, arrhythmias) when clinically indicated.
Psychiatric assessment documentation for concurrent psychiatric illness, suicide risk assessment, and psychosocial evaluation.

For enteral (nasogastric) feeding/re-feeding: documentation of malnutrition status, indication for tube feeding, feeding protocol used, prophylactic phosphate supplementation if used, monitoring of refeeding syndrome parameters, and documentation of short-term weight gain and adverse events.

For pharmacotherapy: documentation of prior treatments and response (e.g., failure of psychotherapy or other agents where relevant), dosing/titration and monitoring of adverse effects (e.g., for lisdexamfetamine monitoring of vital signs, heart rate, weight; for topiramate monitoring cognitive effects and tolerability), and contraindications (e.g., bupropion contraindication for BN).

For experimental/advanced interventions (DBS, NIBS, experimental medications): documentation of treatment refractoriness, informed consent, baseline psychometric and neuroimaging assessments (where performed in trials), and close monitoring and reporting of adverse events.

For screening or research biomarkers (genetic tests, gut microbiota, neuropeptide levels, adiponectin, zinc, olfaction/gustatory testing, EEG biomarkers): documentation that these are investigational/for research or adjunctive use only, with records of informed consent and rationale for testing given the lack of established clinical utility per the document.

Key Coverage Criteria

Treatment: Pharmacotherapy for the treatment of bulimia (e.g., selective serotonin reuptake inhibitors such as fluoxetine, tricyclic anti-depressants, trazodone, topiramate).
Treatment: Pharmacotherapy for the treatment of binge-eating disorder (e.g., lisdexamfetamine dimesylate (Vyvanse)). (Note: Coverage may be excluded under plans that exclude coverage of medications to decrease or increase weight. Please check benefit plan descriptions.)
Management of members with anorexia or bulimia (Medically Necessary services and procedures listed below).
Assessment: Blood count and serum chemistry (e.g., CBC, electrolytes, BUN/creatinine).
Assessment: Bone density measurement (for evaluation of anorexic members).
Assessment: Electrocardiography.

6 Active Policies

ANTHEM-CG-MED-08, Home Enteral Nutrition

AETNA-CPB-0511, Eating Disorders

BCBSIL-MED201.011, Nutritional Support

BCBSMT-MED201.011, Nutritional Support

BCBSNM-MED201.011, Nutritional Support

BCBSOK-MED201.011, Nutritional Support

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S9340, Home therapy; enteral nutrition; administrative services, professional pharmacy