Does S9341 require prior authorization?

No, S9341 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for S9341?

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

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Coverage determinations must include review of the member's benefit contract or Summary Plan Description (SPD) for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).

Oral enteral nutrition (oral feeding) is consideredmedically necessarywhenallof the following criteria are met:
The product constitutes more than 50 percent of the individualâs caloric intake;and
The product must be a medical food for oral feeding;and
The product must be labeled and used for the dietary management of a specific medical disorder, disease, or condition for which there are distinctive nutritional requirements to avert the development of serious physical or mental disabilities or to promote normal development or function as listed in 1.or2. [...]

ANTHEM-CG-MED-08, Home Enteral Nutrition

BCBSIL-MED201.011, Nutritional Support

BCBSMT-MED201.011, Nutritional Support

BCBSNM-MED201.011, Nutritional Support

BCBSOK-MED201.011, Nutritional Support