Louisiana Medicaid DME Enteral Nutrition Fee Schedule

The Louisiana Medicaid program reimburses Durable Medical Equipment (DME) providers for the delivery of enteral nutrition (EN) products and related services. Understanding the current fee schedule is essential for providers, patients, and billing professionals to ensure compliance and proper payment.

What Is Enteral Nutrition?

Enteral nutrition refers to feeding that uses the gastrointestinal (GI) tract to deliver nutrients directly to the stomach or small intestine. It includes formulas, feeding tubes, pumps, accessories, and related services such as nutrition counseling and supplies replacement.

Key Definitions

• DME: Durable Medical Equipment, including feeding pumps and tubes.
• EN Formula: Commercially prepared nutrition formulas prescribed by a qualified health professional.
• Supplemental Feeding (SF): Additional nutrition needs beyond the prescribed formula.
• Renewal: Periodic reassessment and reauthorization of EN services.

Eligibility Criteria for Medicaid Reimbursement

1. Patient must be enrolled in Louisiana Medicaid.
2. Prescription for EN must be written by a physician, nurse practitioner, or dietitian authorized to prescribe nutrition therapy.
3. Documented medical necessity, including diagnosis and clinical indication.
4. All services must be rendered by a Medicaidapproved DME supplier.

Current Fee Schedule (Effective 1January2025)

The following table summarizes the primary reimbursement rates for enteral nutrition items and services. Rates are expressed in U.S. dollars per unit or service and are subject to the annual costcontainment adjustments published by the Louisiana Department of Health (LDH).

HCPCS Code	Description	Unit of Measure	Medicaid Rate*
A4220	Enteral Feeding Supplies, per 30day supply (incl. formula, tubing, connectors)	30day supply	$115.00
A4230	Daily supply of enteral feeding formula, adult, per 1,000kcal	1,000kcal	$12.45
A4231	Daily supply of enteral feeding formula, pediatric, per 1,000kcal	1,000kcal	$13.20
E1530	Enteral feeding pump, per unit	Each	$235.00
K0905	Feeding tube, gastrostomy (Gtube), per unit	Each	$75.00
K0906	Feeding tube, jejunostomy (Jtube), per unit	Each	$82.00
G0169	Nutrition counseling, dietitian, per 15minute session	15min	$22.50
G0170	Nutrition counseling, dietitian, per 30minute session	30min	$40.00
E0130	Home health aide assistance with tube feeding, per 15minute interval	15min	$8.75

*Rates are gross reimbursement amounts before any applicable patient copay, deductible, or contractual adjustments.

Billing Guidelines

1. Use the Correct HCPCS Code

Every claim must contain the appropriate HCPCS code that matches the service or product provided. Incorrect coding results in claim denial or delayed payment.

2. Attach Supporting Documentation

Claims must be accompanied by:

• Physician or dietitian order specifying product type, quantity, and duration.
• Successful completion of a Medicaid Prior Authorization when required (e.g., for pumps or specialty formulas).
• Documentation of patients medical necessity and progress notes.

3. Quantity Limits

Medicaid imposes quantity limits to promote appropriate use:

• Formulas: Maximum of 1,500kcal per day unless a higher amount is justified.
• Supplies: 30day supply per claim; additional supplies require a separate claim with a new authorization.

4. Frequency of Services

Nutrition counseling and home health aide services are limited to:

• Up to 6 counseling sessions per calendar year (unless a higher frequency is documented).
• Home health aide assistance limited to 30 minutes per day, 5 days per week.

Common Claim Denial Reasons & How to Avoid Them

Denial Reason	Explanation	Prevention Strategy
Missing Prior Authorization	Required for pumps, specialty formulas, and some tubes.	Submit the authorization request at least 5 business days before service.
Invalid HCPCS Code	Code does not correspond to the product/service delivered.	Reference the latest Medicaid fee schedule before coding.
Quantity Over Limit	Claim exceeds the 30day supply or kcal limit.	Calculate daily kcal and ensure total does not exceed 1,500kcal/day.
Insufficient Documentation	No physician order or progress note attached.	Maintain a standardized claim packet checklist.
Patient Not Enrolled in Medicaid	Patient's coverage status not verified.	Verify eligibility through the Medicaid Management Information System (MMIS) before service.

Renewal and Reevaluation Process

1. 90Day Review: Providers must submit a renewal request 30 days before the current authorization expires.
2. Clinical Update: Include latest weight, labs, tolerance, and any adverse events.
3. Medical Necessity Reassessment: Confirm that the patient still meets the criteria for EN (e.g., inability to meet nutritional needs orally).
4. Approval: Once approved, a new 90day supply authorization is issued.

Patient CostSharing

Louisiana Medicaid typically requires a modest copay for DME items, but many patients qualify for waivers based on income level:

• Standard copay: $5 per 30day supply of formula.
• Lowincome waiver: No copay for patients whose income is below 138% of the Federal Poverty Level.

Resources & Links

• Louisiana Department of Health DME Fee Schedule
• Louisiana Medicaid Portal (MMIS)
• CMS Medicare Physician Fee Schedule (reference)