Apple Health - Updated Enteral Nutrition Billing Guide available


HCA Logo

Apple Health (Medicaid): Provider Alert

The Health Care Authority has published an updated Enteral Nutrition Billing Guide, effective May 1, 2017.


Changes include a complete reorganization of the guide; several new forms replacing previous forms, including a new prescription form; new requirements for prescribing providers, dietitians, and dispensing providers, particularly related to oral enteral nutrition; and discontinued expedited prior authorization (EPA) numbers.


Major changes include:

  • A new section on thickeners, including:
      • New forms for thickeners
      • New EPA #870001406 for clients age one through 20

  •  A new section on inherited metabolic disorders, including:
      • New forms for formulas
      • New EPA #870001405 for clients age 20 and younger
      • New Exception to Rule (ETR) form for clients age 21 and older

  • A new section on tube-delivered enteral nutrition.

  • A new section on enteral equipment and related supplies, including a new form. 
  • A new section on oral enteral nutrition (please read the new section thoroughly for details), including:
    • New EPA #870001407 for an immediate one-time, one-month supply of oral enteral nutrition product for clients age 20 and younger when the client has an urgent need
    • New EPA #870001408 covers a monthly supply for up to 6 months for clients age 20 and younger when certain criteria are met
    • New prior authorization requirement for all clients requesting oral enteral nutrition products for more than 6 months