Question

According to current Medicare guidelines, coverage for an enteral feeding pump can be justified under which of these circumstances?

1: The patient is being fed using a jejunal feeding tube
2: The patient states a preference to infuse feedings during the night using a pump
3: The patient's caregiver has difficulty preparing several bolus feedings each day
4: The patient would like enteral feedings to infuse quickly.

Answer 1

Option A. Medicare covers an enteral feeding pump when the patient uses a jejunal feeding tube, as it meets the medical necessity. Preferences for night infusion or ease of feeding do not dictate coverage unless medically needed.

Step-by-step explanation:

According to current Medicare guidelines, coverage for an enteral feeding pump can be justified under the circumstance that the patient is being fed using a jejunal feeding tube. The purpose of medical foods and their enteric administration is to ensure that the food bypasses the stomach and is instead broken down in the intestines, which is necessary for patients with certain medical conditions or those who are comatose and cannot eat by mouth.

For Medicare coverage, the patient's medical need takes precedence over convenience or personal preference, thus scenarios where the patient or caregiver prefers night infusion via a pump or has difficulty with bolus feedings, or the patient wishing for quicker infusion, do not meet the coverage requirements on their own unless there is a demonstrable medical necessity.